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HENRY    BAIRD    FAVILL 
1860 —1916 


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HENRY  BAIRD  FAVILL 

A.J3.,  M.D.,  LL.D. 
1860 -1916 


S    ilemorial    Volume 

LIFE,    TRIBUTES,    WRITINGS 


COMPILED    BY   HIS    SON 


CHICAGO 
|)ri\jatelp    |)rtntc5 

1917 


COPYRIGHT,  1917,  BY 
JOHN  FAVILL 


f>1     . 


"i^' 


The  Rand  McNally  Press 


FOREWORD 

'T^IIIS  volume  has  been  prepared  as  a  remembrance  of  my 
father  for  those  who  admired  and  loved  him.  It  seemed 
to  me  that  the  remarkable  number  of  beautiful  tributes  which 
appeared  after  his  death,  and  certain  of  the  many  letters  of 
sympathy  which  were  received  by  my  mother  and  myself,  should 
be  shared  by  others.  The  varied  interests  which  he  had  during 
his  full  life  led  to  the  writing  of  many  papers  and  speeches,  and 
these  I  have  now  collected,  feeling  that,  while  some  may  be  in- 
terested in  them  all,  all  to  whom  I  give  this  book  will  find  in  some 
of  them  thoughts  which  will  bring  happy  recollection,  stimulus, 
and  help.  I  do  not  doubt  that,  could  I  consult  him,  he  would 
have  me  discard  many  of  them.  But  he  will  not  mind  if  he 
knows  how  their  collection  has  been  an  inspiration  to  me.  To 
my  secretary,  Nancy  D.  Sibley,  who  was  my  father's  secretary 
for  twenty  years,  I  now  express  my  deepest  gratitude  for  her 
never-failing,  loyal  interest  and  indispensable  aid  in  the  prepara- 
tion of  this  book. 

John  Favill. 

Chicago, 

November  p,  1917. 


CONTENTS 

PACE 

Portrait Frontispiece 

Foreword v 

Lifetime  Tributes         xii 

Life  of  Henry  Baird  Favill,  Written  for  Kelly  and 
Burrage's    "American    Medical    Biography,"    by 

Dr.  E.  C.  Dudley xiii 

PART  ONE 
TRIBUTES  AND   RESOLUTIONS 
Memorial  Meeting  at  the  City  Club: 

Allen  B.  Pond 3 

Dr.  Frank  Billings 5 

(Charles  R.  Crane) 6 

Prof.  Graham  Taylor 7 

Sherman  C.  Kingsley 10 

Frank  H.  Scott 12 

Other  Memorials  by: 

Board  of  Trustees  of  Rush  Medical  College     .  15 

Wisconsin  Society  of  Chicago       .      .      .      .      .      .  21 

Commercial  Club  of  Chicago 24 

Chicago  Medical  Society 26 

Chicago  Pathological  Society 26 

Trustees  of  the  Elizabeth  McCorimick  Memorial 

Fund 27 

Board    of    Directors    of    the    National    Dairy 

Council 28 

Holstein-Friesian  Association  of  America       .      .  28 

Social  Service  Club  of  Chicago 31 

Cyrus  H.  McCormick 32 

Carl  Sandburg 33 

Rev.  Dr.  E.  G.  Updike 34 

Dr.  Arthur  M.  Corwin 36 

Dr.  Philip  King  Brown 37 

vii 


viii  CONTENTS 

PAGE 

R.  B.  Ogilvie 38 

F.  E.  BoLLiNG 39 

E.  L.  Foley 40 

J.  C.  Williams 42 

Formal  Resolutions  from: 

City  Club  of  Chicago 50 

University  of  Wisconsin  Club  of  Chicago       .      .  51 

Medical  Board  of  St,  Luke's  Hospital       ...  52 

Board  of  Trustees  of  St.  Luke's  Hospital     .      .  52 

Chicago  Society  of  Internal  Medicine       •      •      •  S3 

Chicago  Neurological  Society 54 

Senior  Class  of  Rush  Medical  College     ...  55 
North    Side    Branch    of    the    Chicago    Medical 

Society 55 

Northwestern  University  Settlement   ....  56 

American  Nurses'  Association 57 

National  Committee  for  Mental  Hygiene       .      .  57 

Letters  from  Organizations: 

Lake  Mills,  Wis.,  Neighbors 59 

Central  Illinois  Creamery  Men's  Club     .      .      .  59 

Business  Men's  Dairy  Extension  Movement  .      .  60 
Eastern    States    Agricultural    and    Industrial 

Exposition 60 

Institute  of  Medicine 61 

Alumna  Association,   St.   Luke's  Hospital  Train- 
ing School 62 

Visiting  Nurse  Association  of  Chicago       ...  62 

Three  Arts  Club,  Chicago 63 

Illinois   Society    of   the    Colonial   Dames    of 

America 64 

Associated  Jewish  Charities  of  Chicago  ....  64 


Press  Comment: 

Chicago  Tribune,  Feb.  22,  1916,  Editorial 
Chicago  Herald,  Feb.  22,  1916,  Editorial  . 
Chicago  Evening  Post,  Feb.  22,  1916,  Editorial 
Chicago  Tribune,  Feb.  26,  1916,  "G.  S.  S." 
Chicago  News,  Feb.  26,  1916,  Graham  Taylor  . 


65 
65 
66 

67 
69 


CONTENTS  ix 

PACE 

Minneapolis  Journal,  Mar.  5,  1916,  Editorial  ,      .  70 
Chicago  Tribune,  June    i,    19 16   (Memorial   Com- 
mittee)          71 

Magazine  Notices: 

Manufacturers'  News,  Feb.  24,  igi6      ....  72 
Journal  of  the   American   Medical  Association, 

Feb.  26,  1916 73 

The  Alumna,  St.  Luke's  Hospital  Training  School, 

March,  1916 74 

Harvester  World,  March,  1916 75 

Kimball's  Dairy  Farmer,  March  i,  1916     ...  76 

Brownell's  Dairy  Farmer,  March  i,  1916       .      .  77 

New  Republic,  March  4,  1916 79 

Breeders'  Gazette,  March  9,  1916 79 

Wisconsin  Alumni  Magazine,  April,  1916    .      .      .  81 

Open  Air  Smile,  February,  191 7 82 

Dr.  Favill's  Funeral 86 

The  Henry  B.  Favill  School  of  Occupations   ...  87 

Report  of  the  Memorial  Committee 88 

PART  TWO 
ADDRESSES  AND  PAPERS  OF  HENRY  BAIRD  FAVILL 

I.     MEDICINE   AND   PUBLIC   HEALTH 

Diet  and  Disease 91 

Treatment  of  Chronic  Nephritis 103 

Toxic  Correlation 108 

Modern  Methods  of  Medical  Instruction   .      .      .      .  117 

Treatment  of  Arteriosclerosis 123 

Treatment  of  Acute  Rheumatism 131 

The  Rational  Diagnosis 143 

Chorea:  Especially  in  Relation  to  Rheumatism  and 

Endocarditis 153 

Treatment  of  Typhoid  Fever 161 

Venesection 169 

Am  I  My  Brother's  Keeper? 178 

The    Development    of    the    Conception    of    Physical 

Well-being 197 


X  CONTENTS 

PAGE 

Tuberculosis 211 

Social  Aspects  of  Tuberculosis 217 

Playgrounds  in  the  Prevention  of  Tuberculosis       .  226 

School  Playgrounds     237 

President's  Address  to  the  Chicago  Medical  Society    .  242 
Legitimate  Exercise  of  Police  Power  for  the  Pro- 
tection OF  Health 248 

The  Federal  Children's  Bureau 257 

Medicine  in  the  Scheme  of  Conservation    ....  262 

Mental  Hygiene 274 

Upon  What  Ground  May  the  State  Assume  the  Direc- 
tion of  Public  Health? 288 

Should  the  Public  School  Be  the  Bulwark  of  Public 

Health? 295 

The  Responsibility  of  the  Medical  Profession   .      .  313 
The  Attitude  of  the  Medical  Profession  Regarding 

Medical  Practice  Laws 318 

The  Toxin  of  Fatigue 328 

The  Management  of  Defective  Children    .      .      .      .340 

Child  Labor  as  Related  to  the  Stage 347 

Problems  of  Visiting  Nurses 356 

The  Importance  of  the  Visiting  Nurse 365 

Rural  Hygiene 367 

Child  Culture  the  Function  of  Organized  Medicine  376 

The  National  Department  of  Health 398 

Health  and  Its  Relation  to  Business 406 

What   the    Medical   Profession   Can   Contribute   to 

Nursing  Education        409 

The  Public  and  the  Medical  Profession,  a  Square  Deal  418 

II.     AGRICULTURE   AND   DAIRYING 

Tuberculosis  in  Cattle 441 

The  Health  and  Development  of  the  Dairy  Cow     .  457 

Buying  and  Selling  Livestock 468 

Acceptance  of  Ex-Governor  Hoard's  Portrait      .      .  482 

Problems  of  the  Dairy  Industry 486 

The  Call  to  Arms 501 

What  Should  Be  Done  to  Protect  Our  Livestock?   .      .  508 


CONTENTS  xi 

PACE 

TiiK  Effect  ok  tiii':  War  on  Tiiii  Holstein  Business   .      .  513 

The  Value  of  Purebred  Cattle 515 

The  Development  of  the  Dairy  Industry    ....  530 

III.     MISCELLANEOUS 

A  Way  of  Life 549 

Smoking 557 

The  Profession  of  Medicine  as  a  Vocation      .           .  559 

Civic  Piety 568 

Sketch  of  John  Favill,  M.D 577 

Nicholas  Senn  as  a  Physician 580 

Our  Lakes  and  Woods 583 

Supporting  the  Candidacy  of  C.  E.  Merriam   .      .      .  589 

Remarks  on  the  Report  of  the  Vice  Commission    .      .  592 

Wishbones  and  Backbones 594 

Early  Medical  Days  in  Wisconsin 601 

Trifles  and  Ideals       . 614 

Unselfishness 625 

Have  an  Outside  Interest 635 


FAVILL,    HENRY    BAIRD    (i«6o— 1916) 

A   Biographical   Sketch 

[Written  for  Kelley  and  Burrage's  American  Medical  Biog- 
raphy, by  Dr.  E.  C.  Dudlky.] 

FAVILL,  HENRY  BAIRD,  physician,  was  born  at 
Madison,  Wis.,  August  14,  i860,  son  of  John  and 
Louise  Sophia  (Baird)  Favill.  His  first  paternal 
American  ancestor  was  John  Favill,  who  came  to  this  coun- 
try from  England  some  time  before  the  Revolution,  and, 
after  fighting  in  the  Continental  Army,  settled  in  the  town 
of  Manheim,  Herkimer  County,  N.  Y.  From  him  and  his 
wife,  Nancy  Lewis,  the  line  of  descent  is  traced  through 
their  son,  John  Favill,  and  his  wife,  Elizabeth  Guile.  Their 
son,  John  Favill,  and  his  wife,  Louise  Sophia  Baird,  were 
the  parents  of  Henry  Baird  Favill.  His  father  was  a  lead- 
ing physician  in  Wisconsin,  a  member  of  the  first  state 
board  of  health,  and  president  of  the  Wisconsin  State  Medi- 
cal Society  in  1873.  Henry  Baird  Favill  was  a  descendant 
through  the  maternal  line  from  the  Ottawa  chief  Kewino- 
quot,  "Returning  Cloud,"  and  was  especially  proud  of  his 
Indian  ancestry.     The  Indian  line  is  as  follows: 

1.  The  Ottawa  chief  Kewinoquot  and  wife  Mijik. 

2.  The  Princess  Migisin,  baptized  Marie,  daughter  of 
Kewinoquot,  educated  by  the  missionaries  at  Mackinac 
Island,  married  Jean  Baptiste  Marcotte. 

3.  Therese  Marcotte,  daughter  of  Migisin,  married 
(i)  Pierre  La  Saliere,  and  (2)  George  Schindler.  She  was 
well  known  as  Madame  Schindler. 

4.  Marianne  La  Saliere,  daughter  of  Madame  (La 
Saliere)  Schindler,  married  Henry  Monroe  Fisher.  Mrs. 
Fisher  translated  numerous  religious  books,  including  parts 
of  the  Bible,  from  the  French  into  the  Ottawa  language. 
These    translations    have    been    extensivety    used    by   the 


xiv  HENRY      BAIRD      FAVILL 

missionaries  among  the  Indians.  Mrs.  Fisher  was  the  head 
of  a  widely  recognized  school  attended  by  daughters  of  the 
most  influential  white  families  and  by  Indian  giris  as  well. 

5.  Elizabeth  Therese  Fisher,  daughter  of  Marianne  La 
Saliere  Fisher,  married  Henry  S.  Baird  of  Green  Bay,  Wis. 

6.  Louise  Sophia  Baird,  daughter  of  Elizabeth  Therese 
Baird,  married  Dr.  John  Favill  of  Madison,  Wis. 

7.  Dr.  Henry  Baird  Favill  was  the  only  son  of  Louise 
Favill. 

Although,  as  will  be  seen  from  the  above,  Dr.  Favill 
was  only  one  thirty-second  part  Indian,  his  physical  ap- 
pearance would  have  enabled  him  to  pass  as  immeasurably 
more  Indian  than  white. 

Dr.  Favill  was  a  graduate  of  the  Madison  High  School, 
of  the  University  of  Wisconsin,  A.  B.,  in  1880,  and  of  Rush 
Medical  College,  M.  D.,  in  1883.  In  this  latter  year  he  was 
an  intern  at  Cook  County  Hospital,  Chicago,  and  then 
became  associated  in  practice  in  Madison  with  his  father, 
who  died  a  few  months  later.  In  1885  he  married  Miss 
Susan  Cleveland  Pratt  of  Brooklyn,  N.  Y.  For  three  years 
he  lectured  on  Medical  Jurisprudence  in  the  Law  Depart- 
ment of  the  University.  In  1894  he  left  a  large  practice 
in  medicine  and  surgery  in  Madison,  and  removed  to 
Chicago  to  accept  simultaneous  calls  to  the  Chair  of  Medi- 
cine in  the  Chicago  Policlinic,  and  to  an  adjunct  Chair  of 
Medicine  in  Rush  Medical  College,  from  which  latter  he 
was  promoted  in  1898  to  the  Ingals  Professorship  of  Pre- 
ventive Medicine  and  Therapeutics,  and  in  1906  to  the 
Chair  of  Clinical  Medicine. 

His  practice,  now  confined  to  internal  medicine,  soon 
became  large  and  influential  and  his  reputation  rapidly 
assumed  a  national  character.  At  different  times  he  was 
officially  connected  with  numerous  hospitals,  among  them 
the  Augustana  Hospital,  the  Passavant  Memorial  Hospital, 
and  St.  Luke's  Hospital,  of  which  last,  at  the  time  of  his 
death,  he  was  president  of  the  Medical  Board.     One  of  the 


BIOGRAPHICAL      S  K  K  T  C  If  xv 

many  medical  organizations  in  whicli  he  took  great  interest 
was  the  Chicago  Tuberculosis  Institute  of  which  for  many 
years  he  was  president.  Some  of  the  medical  organizations 
of  which  he  was  a  member  are:  The  Chicago  Society  of 
Internal  Medicine,  Chicago  Institute  of  Medicine,  Physi- 
cians' Club  of  Chicago,  Illinois  and  Wisconsin  State  Medical 
Societies,  and  the  Chicago  Medical  vSociety,  of  which  he 
was  president  in  1907-08.  He  was  an  influential  member 
of  the  National  Association  for  the  Study  and  Prevention 
of  Tuberculosis,  the  National  Committee  for  Mental 
Hygiene  (being  elected  its  first  president  in  1909),  and  was 
a  Fellow  of  the  American  Medical  Association.  From  the 
time  of  its  formation  in  1910,  he  was  chairman  of  the 
Council  on  Health  and  Public  Instruction  of  the  A.  M.  A. 
His  club  memberships  included  the  University,  City,  Saddle 
and  Sirloin,  and  Commercial.  He  was  the  only  man  with- 
out commercial  connections  in  Chicago  ever  elected  to  the 
latter  organization.  His  fraternities  were  Beta  Theta  Pi 
and  Nu  Sigma  Nu,  and  he  was  elected  to  the  Phi  Beta 
Kappa  Society  when  the  University  of  Wisconsin  installed 
a  chapter  years  after  his  graduation.  He  held  the  rank  of 
First  Lieutenant,  U.  S.  A.  Medical  Reserve  Corps,  and  the 
degree  of  LL.  D.  from  Wisconsin. 

Although  not  a  voluminous  writer,  his  lectures  and  con- 
tributions to  medical  literature  abounded  in  originality  of 
thought  and  expression.  One  of  the  more  significant  of 
these  was  "The  Public  and  the  Medical  Profession,  a  Square 
Deal,"  delivered  before  the  Penns^dvania  State  Medical 
Society  in  1 9 1 5 . 

In  1 9 10  he  was  president  of  the  Municipal  Voters' 
League,  during  which  period  he  exhibited  sound  and 
unbiassed  judgment,  strongly  and  fearlessty  opposing  those 
who  favored  impure  politics.  He  was  president  of  the 
City  Club,  1910-1912,  serving  as  one  of  its  directors  from 
1905,  and  at  one  time  as  chairman  of  the  Committee  on 
Public  Affairs.     Independent  in  politics,  he  was  a  leader 


xvi  HENRY     BAIRD     FAVILL 

in  the  cause  of  good  government,  municipal  improvement, 
and  sanitar}^  progress,  and  was  for  many  years  a  trustee 
of  the  Chicago  Bureau  of  PubHc  Efficiency  and  a  director 
of  the  United  Charities. 

During  the  last  eight  years  of  his  life  he  became  intensely 
interested  in  cattle  breeding  and  the  dairy  industry  and  gave 
most  of  his  spare  time  during  these  years  to  the  building  up 
of  a  model  stock  farm,  "  Milford  Meadows,"  at  Lake  Mills, 
Wis.  His  deep  study  and  application  to  agricultural  and 
breeding  problems  led  to  the  writing  of  many  important 
articles  and  lectures  on  these  subjects,  and  to  his  election 
as  vice-president  of  the  Holstein-Friesian  Association  of 
America,  and  president  of  the  National  Dairy  Council. 
It  was  during  a  visit  to  Springfield,  Mass.,  in  connection 
with  the  latter  organization,  that  he  succumbed  to  a  viru- 
lent attack  of  pneumonia,  leaving  his  widow  and  one  son, 
Dr.  John  Favill,  on  February  20,  191 6. 

No  other  physician  in  America  was  so  widely,  sym- 
pathetically, and  intimately  related  to  movements  of  public 
welfare,  to  all  of  which  by  temperament  he  was  singularly 
adjusted.  A  lover  of  outdoor  life,  he  frequently  indulged 
in  long  walks  regardless  of  temperature,  rain,  or  snow, 
believing  in  plenty  of  exercise  rather  than  abundant  cloth- 
ing. Optimistic,  just,  determined,  upright,  a  vigorous 
thinker,  and  an  astute  reasoner,  he  had  the  rare  quality  of 
getting  at  the  gist  of  things,  of  seeing  through  non-essential 
details  to  the  real  point  at  issue,  and  so  his  judgment  was 
in  constant  demand  in  a  wide  field  of  medical,  civic,  and 
political  problems,  the  most  intricate  of  which,  because  of 
his  scientific  and  dispassionate  mind,  he  was  able  to  solve. 
Add  to  these  qualities  a  rare  and  subtle  humor,  of  which 
this  is  an  example :  When  Mrs.  Favill  was  elected  a  Colonial 
Dame,  some  reporters  called  upon  him  and  facetiously 
inquired  whether  he  could  not  qualify  for  the  Society  of 
the  Mayflower.  "No,"  he  said,  "my  people  were  on  the 
reception  committee." 


BIOGRAPHICAL     SKKTCfl  xvii 

At  the  time  of  his  funeral,  Rev.  F.  W.  Gunsaulus,  a 
warm  personal  friend,  said:  "The  personality  of  Dr.  Favill 
exalted  the  work  and  achievements  of  the  physician  as  well 
as  the  practical  reformer  in  the  city  of  Chicago.  No  man 
more  sanely  or  nobly  incarnated  ideals  which  are  higher 
than  any  calling  and  as  great  as  any  enthusiasm." 

As  The  Chicago  Evening  Post  said,  "Dr.  Favill  was  a 
man  who  held  in  a  city  of  over  2,000,000  inhabitants  the 
position  of  love,  dignity,  and  influence  held  by  many  a 
lesser-known  'country  doctor'  in  the  villages  of  America." 


LIFETIME  TRIBUTES 

"With  him,  too,  we  see  comprehensive  mental  vision,  and  dominant 
purpose  nobly  directed,  guided  by  splendid  judgment,  a  keen  reading  of 
character  and  of  the  signs  of  events,  and  an  overmastering  sense  of  justice. 
His  splendid  qualities,  coupled  with  an  iron  frame  to  carry  the  burden  of  all 
that  the  mind  devises,  are  freely  given  to  useful  public  service,  and  suffusing 
all,  a  warmth  of  feeling  and  delicacy  of  sense  that  insures  the  highest  uses 
of  his  gifts."  —Dr.  Frank  S.  Johnson,  1908. 

"One  I  know  .  .  .  a  doctor  in  Chicago  whose  American  lineage  stretches 
far  back  of  the  'Mayflower,'  back  of  any  pale-faced  newcomer  to  this  con- 
tinent. I  do  not  forget  that  as  doctor  and  as  civic  leader  he  has  put  Chicago 
and  the  whole  country  deeply  in  his  debt.  But  my  memory  picture  of 
him  (and  yours  if  you  know  him,  as  you  probably  do)  will  live  to  inspire 
and  rebuke  us  even  when  we  forget  Chicago  and  civics  and  medical  ideals. 
For  they  are  only  part  of  life,  while  our  friend  F.  is  the  very  incarnation 
of  life  as  he  moves  in  the  city  streets.  He  brings  the  open  country  with  him 
and  the  untarnished  freedom  of  mountain  air.  You  can  learn  both  '  the  cause 
and  the  cure  of  civilization'  if  you  will  walk  with  him  on  Michigan  Avenue; 
for  nothing  in  modern  civilization  has  cramped  him,  not  even  its  'serious' 
clothes!"         —Dr.  Richard  C.  Cabot,  "What  Men  Live  By,"  1914. 

"Henry  Baird  Favill,  thirty- five  years  ago  you  graduated  from  this 
University,  and  after  having  completed  a  course  in  medicine  at  Rush  Medical 
College,  Chicago,  you  returned  to  Madison  and  for  a  number  of  years  prac- 
ticed medicine  here  with  distinguished  success.  You  then  went  to  Chicago 
where  larger  fields  were  open  and  achieved  a  like  success  in  the  practice  of 
medicine  there,  as  well  as  in  the  teaching  of  medicine  as  Professor  of  Clinical 
Medicine  at  Rush  Medical  College  and  the  Chicago  Policlinic.  While 
busily  engaged  as  a  practitioner  and  teacher  you  have  nevertheless  found 
time  to  render  important  public  service  in  the  promotion  of  a  public  under- 
standing of  the  needs  of  sanitation  and  preventive  medicine,  and  have  been 
a  leader  both  in  local  and  in  national  movements  which  have  had  as  their 
ends  the  promotion  of  preventive  medicine.  In  this  work  you  have  illus- 
trated what  we  like  to  believe  the  true  Wisconsin  idea,  active  service  for 
the  public  in  appreciation  of  the  benefits  derived  from  public  education. 
As  a  devoted  alumnus,  eminent  physician,  honored  teacher,  distinguished 
leader  in  the  development  of  social  welfare  through  the  development  of 
preventive  medicine,  upon  recommendation  of  the  University  faculty,  and  by 
authority  of  the  Regents,  I  confer  upon  you  the  honorary  degree  of  Doctor  of 
Laws."     — President  Van  Hise,  University  of  Wisconsin,  June  16,  1915. 

"The  man  was  greater  than  his  work.  In  all  the  fundamentals  of  great- 
ness, simplicity,  purpose,  steadfastness,  reverence,  he  was  preeminent,  and 
the  results  he  achieved  are  the  direct  expression  of  his  character." 

— From  an  article  on  Pasteur,  author  unknown,  sent  years  ago  by 
a  friend  as  a  fitting  portrait  of  Dr.  Favill. 


PART   ONE 


TRIBUTES    AND    RESOLUTIONS 


HENRY   BAIRI)   FAVILI 

3    illemorial    Volume 


PART  ONE 

Tributes  and  Resolutions 


MEMORIAL  MEETING  AT  THE  CITY  CLUB 

IN  recognition  of  Dr.  Favill's  leadership  in  the  activities 
of  this  club,  of  which  for  two  years  he  was  President, 
and  of  his  many  important  contributions  in  the 
field  of  public  medicine,  of  social  service,  and  of  civic 
betterment  in  Chicago,  the  Directors  of  the  City  Club  on 
February  21,  191 6,  adopted  resolutions  and  arranged  a 
memorial  meeting,  which  was  held  at  the  club  on  the  after- 
noon of  February  26.  The  speakers  were  introduced  by 
Allen  B.  Pond,  President  of  the  Club,  who,  in  opening  the 
meeting,  said: 

"Henry  Favill  —  erect,  lithe,  the  head  thrown  back,  the 
elastic  tread,  the  swinging  stride,  joyous  vigor  incarnate: 
it  seemed  that  he,  of  all  men,  should  for  years  to  come  resist 
the  attacks  of  disease,  the  ravages  of  time.  And  yet  —  last 
Sunday  in  the  faint  gray  of  the  early  dawn  that  splendid 
spirit  slipped  away  into  the  eternal  silence. 

"It  is  fitting  that  we  of  the  City  Club  should  meet  to-day 
to  honor  his  memory,  to  pay  our  tribute  to  his  worth.  He 
was  a  charter  member  of  the  Club;  and  from  the  close  of 
its  second  year  to  the  day  of  his  death  he  served  continuously 
on  its  board  of  managers  —  as  director,  chairman  of  its  public 
affairs  committee,  as  president,  and  then  again  as  director. 
We  shall  miss  him  sorely,  we  who  knew  him,  we  who  admired 


4  HENRY     BAIED     FAVILL 

him,  we  who  were  proud  of  him,  we  who  loved  him.  We 
shah  miss  his  wise  counsel,  his  large  patience,  his  charity 
of  mind,  his  unwavering  courage.  Yet  even  though  we  are 
met  to-day  to  voice  our  grief  at  his  death  and  our  keen  sense 
of  deprivation,  our  feeling  is  not  wholly  that  of  grief.  For 
even  in  our  grief  we  rejoice  that  he  was  the  man  that  he  was, 
had  the  thoughts  that  were  his,  did  the  deeds  that  he  did, 
and  that,  he  being  such  as  he  was,  it  fell  to  us  to  know 
him  and  count  him  as  one  of  us. 

"He  w^as  not  content  to  be  borne  along  on  the  current 
of  life  —  drifting  and  aimless  like  a  chip  in  a  stream.  Always 
he  breasted  the  current  with  a  heart  of  controversy,  shaping 
his  course  by  a  dimly  seen  but  none  the  less  truly  appre- 
hended ideal. 

"He  looked  out  on  life  from  many  angles  and,  from 
whatever  angle  he  chanced  to  look,  he  sought  'to  see  life 
steadily  and  see  it  whole.'  He  touched  life  at  many  points; 
and  wherever  he  laid  his  hand,  he  helped  to  do  the  task 
or  to  lighten  the  load.  He  was  in  very  truth  a  tower  of 
strength. 

"We  shall  not  wholly  replace  him;  nor  yet  shall  we 
forget  him.  From  time  to  time  the  thought  of  him  will 
epring  forth  into  consciousness.  And  whenever  we  think 
of  him  and  what  he  was,  we  shall  thrust  to  one  side  our 
inconclusive  wrestling  with  the  enigma  of  life,  our  half- 
hearted surmise  of  its  futility,  shall  tighten  our  belts  and 
say  in  our  hearts:  Whatever  it  be  or  whencesoever  it 
came,  life  that  bears  such  fruitage  is  not  to  be  despised; 
and,  come  what  may,  it  is  worth  while  to  have  shared  life's 
chances  —  its  failures  and  its  victories  —  in  the  company 
of  such  as  he. 

"First  and  foremost  Henry  Favill  was  the  physician 
who  tries  to  relieve  the  suffering  of  those  who  seek  his  ser- 
vice; but,  high  as  is  this  service,  he  did  not  rest  with  this: 
he  was  also  the  physician  who  strives  to  ascertain  the  more 
remote  conditions  that  environ  our  lives  and  that  cause 


TRIBUTES      AND      RESOLUTIONS  5 

or  pave  the  way  for  disease  and  who  seeks  those  larger 
remedial  measures  which  society  itself  must  organize  if  we 
are  to  strike  disease  at  its  very  roots.  This  aspect  of  Dr. 
Favill's  hfe  will  be  dealt  with  by  one  who  knew  him  in  his 
early  manhood,  and  who  has  been  associated  with  him 
throughout  his  professional  career  —  Dr.   Frank  BilHngs." 

DR.    FRANK    BILLINGS 

"I  have  known  Dr.  Henry  Baird  Favill  for  thirty-five 
years.  When  I  first  knew  him  he  was  a  student  at  Rush 
Medical  College,  from  which  he  graduated  in  1883  with  high 
honors  and  a  reputation  of  a  rational  thinker  on  medical 
subjects. 

"The  illness  of  his  father,  a  physician,  necessitated  his 
location  with  him  in  Madison,  Wis.,  where  he  assumed  the 
responsibility  of  the  care  of  the  family  and  of  his  father's 
practice.  Inexperienced  as  he  was,  he  cheerfully  and  suc- 
cessfully fulfilled  his  obligations.  After  ten  years  of  most 
satisfactory  medical  service  to  a  large  community,  with 
Madison  as  the  center,  upon  the  solicitation  of  many  medical 
and  lay  friends  he  removed  to  Chicago  in  1894.  Dr.  Favill's 
medical  history  in  Chicago  was  that  of  a  successful  man, 
as  a  practitioner,  as  a  family  adviser,  and  as  a  social  service 
and  civic  worker.  As  a  family  physician  he  was  ideal. 
He  carried  his  optimism  and  hopefulness  to  the  sickroom. 
He  aroused  confidence  and  faith  in  his  skill  to  manage  the 
patient  and  his  illness  to  a  successful  issue.  He  aroused 
in  the  minds  of  the  patient  and  of  the  family  a  confidence 
in  matters  not  medical,  and  many  leaned  upon  him. 

"He  became  a  clinical  teacher  in  his  alma  mater  in  1S93 
and  in  this,  as  in  his  other  w^ork,  he  gave  satisfaction  to  his 
colleagues  and  to  the  student  body.  For  many  years  he 
was  attending  physician  at  St.  Luke's  Hospital  and  took 
an  active  part  in  the  continued  development  of  that  great 
institution.  He  was  president  of  its  staff  at  the  time  of 
his  death.     For  six  years  Dr.  Favill  was  chairman  of  the 


6  HENRY     BAIRD     FAVILL 

Council  on  Health  and  Public  Instruction  of  the  American 
Medical  Association.  He  made  the  work  of  the  Council 
of  great  importance  to  the  entire  community  by  cooperating 
with  and  coordinating  the  function  of  hundreds  of  organi- 
zations all  over  the  country  which  were  attempting  to 
improve  the  physical  and  social  condition  of  mankind.  He 
prided  himself  on  his  ancestry,  and  from  his  maternal  grand- 
parents undoubtedly  inherited  a  love  of  out-of-door  life. 
Perhaps  it  was  this  which  aroused  his  great  interest  in  the 
improvement  of  living  conditions  of  the  poor  and  of  others, 
and  in  the  establishment  of  playgrounds,  bathing  beaches, 
and  other  conditions  intended  to  improve  the  general 
hygiene   of   the  people. 

Dr.  Favill  had  a  magnificent  physique  and  a  great  brain 
was  housed  in  his  massive  head.  He  was  a  manly  man. 
He  had  a  wonderful  mental  poise,  continued  optimism,  and 
the  gentleness  of  a  woman.  But  with  all,  he  was  firm, 
upright,  and  a  decided  opponent  of  all  evil. 

"Your  loss  and  mine  seem  irreparable,  and  yet  we  know 
that  great  as  was  the  place  which  Favill  filled  in  this  and 
in  the  larger  community  of  our  country,  some  one  else  will 
take  up  his  work  and  do  it,  if  not  as  adequately  as  he,  will 
still  do  it  and  the  world  will  move  on.  But  I  am  quite 
sure  that  the  spirit  of  Favill  will  live  and  that  we  will  all 
remember  what  he  taught  and  how  he  lived  and  will  join 
in  saying:     'We  thank  God  that  he  gave  us  Favill.'  " 

Following  Dr.  Billings'  remarks,  the  chairman  read  the 
following  telegram  from  Charles  R.  Crane: 

"Dear  Mr.  Pond: 

"I  deeply  regret  that  an  important  and  immovable  engagement 
in  Washington  on  Friday  evening  with  another  devoted  public 
servant  prevents  me  from  being  with  you  on  Saturday  and  testi- 
fying in  person  to  the  feeling  we  all  share  of  the  irreparable  loss 
Chicago  has  sustained  in  the  passing  away  of  Dr.  Favill. 

"The  well  of  his  human  sympathies,  although  always  being 


TRIBUTES      AND      R  F<:  S  f )  I.  Ij  T  I  O  N  S  7 

drawn  ui)on,  seemed  never  to  k^se  its  flow.  As  a  physician  and 
as  a  friend  he  was  just  as  thouj^'htful  and  tender  of  the  small 
miseries  of  life,  which  have  so  much  to  do  with  our  comfort  and 
efficiency,  as  he  was  of  the  larger  affairs  of  the  city,  which  mean 
so  much  in  making  it  a  habitable  place  and  one  of  which  we  could 
be  proud.  To  encourage  any  one  else  who  was  working  in  this 
direction  he  was  always  there  with  his  splendid  talents,  his  won- 
derful vision,  and  his  fine  presence.  There  was  no  evasion,  nor 
excuse,  nor  rest.  It  is  because  he  gave  his  all  that  we  have  had 
to  part  with  him  now,  when  it  seemed  as  though  he  still  had  many 
years  of  continuing  his  rarely  useful  life. 

"To  few  is  such  capacity  for  public  service  given;  and  we 
can  only  hope  that  for  many  years  to  come  his  story  will  be  widely 
known  and  lead  others  to  follow  in  his  footsteps.  But  not  to 
many  others  of  our  fellow  citizens  could  the  words  so  fittingly 
apply:     'Well  done,  thou  good  and  faithful  servant.'  " 

President  Pond:  "Dr.  Favill  touched  the  city  on 
even  another  side  than  that  of  medicine.  He  had  the  true 
Greek  spirit  of  loyalty  to  his  city,  thorough-going  devotion, 
the  feeling  that  every  man,  no  matter  what  his  profession 
or  special  task  might  be,  had  in  addition  thereto  a  civic 
duty.  It  is  with  this  aspect  of  Dr.  Favill's  life  that  Dr. 
Graham  Taylor  will  deal." 

GRAHAM    TAYLOR 

"The  unity  of  life  has  rarely  found  finer  or  more  varied 
expression  than  in  the  personality  of  Dr.  Henr\'  Baird 
Favill.  At  the  last  meeting  of  the  Physicians'  Club,  he 
struck  what  might  have  been  the  ke^'^note  of  his  life,  to 
which  at  least  his  varied  activities  seemed  to  be  attuned. 
He  said: 

'"Most  of  the  things  that  have  become  matters  of  common 
knowledge,  more  or  less  accurate,  finalty  are  elucidated  and 
classified  and  systematized  by  science.  Science  rarely  is  the 
pioneer  in  knowledge.  Science  is  the  final  expoiuider  and  clari- 
fier  of  knowledge.' 


8  HENRY      BAIRD     FAVILL 

"To  a  rare  degree  this  pioneering  common  knowledge 
and  this  clarifying  science  constituted  and  actuated  the 
mind  and  achievements  of  Dr.  Favill.  To  all  his  thinking 
and  action  he  instinctively  brought  all  the  common  thought 
and  human  feeling  which  gathered  about  any  subject  or 
situation,  and  let  them  find  expression  through  the  clarifying 
light  and  heat  of  his  scientific  self -exaction. 

* '  The  charm  of  him  was  that  as  a  man  of  science  he  was 
always  and  wholly  human  in  letting  by-play  and  toil,  the 
light  touch  and  the  heavy  task,  rippling  humor  and  cour- 
ageous decision  mingle  in  his  relations  at  every  turn  of  his 
multifarious  life. 

"It  w^as  just  these  human  and  scientific  qualities  and 
resources  in  such  complete  combination  that  gave  such 
efficiency  and  driving  power  to  Henry  B.  Favill's  citizen- 
ship. The  whole  man  was  the  citizen.  His  citizenship 
was  himself — -all  that  he  was  and  had,  or  could  become, 
personally  and  professionally.  He  held  himself  and  his 
profession  as  a  public  trust. 

"So  much  more  public-spirited  was  he  than  merely  pro- 
fessional that  he  never  hesitated  to  urge  the  community 
to  go  to  any  length  to  safeguard  the  public  health,  at  what- 
ever cost  to  practitioners  in  his  profession. 

"Realizing  the  need  of  reinforcement  and  continuity  in 
the  movem^ent  for  higher  civic  administration  and  ideals,  he 
became  a  charter  member  of  the  City  Club  of  Chicago  and 
bore  his  own  full  share  of  initiative  in  projecting  its  work 
over  which  he  presided  for  two  years  as  president  of  the 
Club.  His  presence  and  the  part  he  took  in  its  discussions 
and  work  always  became  the  point  at  which  the  interest, 
confidence,  and  action  of  the  membership  readily  rallied. 

' '  It  seemed  hardly  possible  that  he  would  or  could  under- 
take the  arduous,  unending,  disturbing,  perilous  work  in- 
volved in  the  presidency  of  the  Municipal  Voters'  League. 
But  he  did,  in  response  to  what  was  not  so  much  a  call  of 
duty  as  an  opportunity  to  serve  his  city  by  bearing  his 


T  R  I  IM I  T  E  S      ANT)      K  l'.  S  O  L  L'  T  I  O  N  S  f; 

share  of  its  pii])lic  burdens.  To  the  perplexities  of  the 
league's  personal  and  public  problems,  he  brought  that 
clarity  of  judgment,  in  which  loyalty  to  fact  and  suscep- 
tibility to  the  human  touch,  combined  to  make  him  as  just 
as  he  was  considerate,  as  firm  as  he  was  fearless.  At  no 
loss  either  of  income  or  of  fellowship  did  he  hesitate  or  com- 
plain. Here  as  everywhere  he  stood  out  in  the  open  and 
took  what  was  coming  to  him  in  being  a  man  among  men. 

"Special  interests  had  as  little  standing  with  him  as 
special  legislation.  For  the  sake  of  public  safety  and  the 
common  welfare,  he  effectively  promoted  protective  and 
constructive  industrial  legislation,  not  only  for  protection 
against  occupational  diseases  and  dangerous  machinery, 
but  also  for  such  compensation  for  injury  and  death  as  is 
just  to  employer  and  employe  alike.  The  American  Asso- 
ciation for  Labor  Legislation  had  no  more  wise  or  practi- 
cally effective  adviser  than  he. 

"Still  more  intensively  and  technically  he  knew  the 
science  of  government  would  have  to  be  applied  to  our 
municipal  administration  if  it  ever  were  to  attain  the  effi- 
ciency demanded  by  public  welfare.  Therefore,  he  was 
foremost  in  proposing,  guiding,  and  supporting  the  Bureau 
of  Public  Efficiency.  There  he  manifested  the  versatility 
of  the  professional  man  who  could  turn  business  man,  of 
the  diagnostician  who  could  judge  accounting,  of  the  pathol- 
ogist who  could  become  adviser  to  the  administrator.  And 
nearest  the  people,  he  was  just  as  much  at  home  in  support- 
ing the  settlement  work  as  a  trustee  of  Chicago  Commons 
and  in  sharing  the  neighborhood  festivities  at  Hull  House. 

"What  magnificent  proportions  and  fine  strong  fibre 
he  had!  He  was  so  virile  in  intellect,  scientific  in  self- 
exaction,  broad  in  his  interests,  analytical  and  synthetic 
in  capacity,  quick  in  apprehension  yet  mature  in  judg- 
ment, just  in  caution  yet  prompt  in  decision.  In  action  he 
was  gloriously  public-spirited,  self-abnegating,  and  fearless. 
Far  flung  in  vision,  he  was  so  human  withal,  alike  when 


lo  HENRY      BAIRD     FAVILL 

under  the  severest  stress  and  strain  of  his  work  or  in  the 
abandon  of  his  rolhcking  play.  The  like  of  him  we  have 
not  among-  us." 

President  Pond:  "Dr.  Favill  gave  his  thought  to 
those  constructive  measures  that  look  toward  the  future, 
but  he  also  realized  that  we  are  carrying  with  us  many  men 
who  have  fallen  short  in  the  race,  people  who  might  be 
considered  derelicts,  and  that  something  must  be  done 
for  them  not  only  by  individual  helpfulness  but  by  organized 
community  effort  and  organized  charity.  It  is  with  these 
aspects  of  his  life  that  Mr.  Sherman  C.  Kingsley  will  deal." 

SHERMAN    C.    KINGSLEY 

"It  is  my  very  great  privilege  to  have  known  Dr.  Favill 
over  a  number  of  years  in  connection  with  the  field  we  know 
as  social  service,  and  to  say  a  few  words  about  his  work 
along  that  line. 

' '  Dr.  Favill  was  an  officer  and  director  in  a  great  number 
and  variety  of  civic  and  philanthropic  organizations.  He 
would  have  been  in  the  same  relation  to  many,  many  more, 
had  it  been  humanly  possible  for  him  to  respond,  for  the 
demands  upon  him  were  constant  and  unremitting. 

"There  was  something  about  his  presence,  his  genial, 
commanding  personality,  which  drew  people  to  him.  His 
qualities  of  mind  and  heart,  his  rare  judgment,  his  poise 
and  vision,  his  sincerity,  revealed  him  as  a  source  of  strength 
which  was  eagerly  sought,  not  only  by  the  organizations 
charged  with  the  delicate  and  difficult  task  of  administering 
the  affairs  of  the  social  service  field,  but  also  by  the  social 
workers  themselves,  who  perhaps  in  a  particular  way  know 
and  feel  the  need  of  genuine  leadership,  of  advice,  of  encour- 
agement, of  sympathy  and  of  strength. 

"Dr.  Favill  was  especially  sought  by  such  agencies  and 
individuals  in  their  big  problems  and  perplexities,  and  no 
one,  I  believe,  ever  went  to  him  on  such  a  quest,  who  came 


TRIBUTES      AND      R  1<:  S  O  L  l'  T  I  C)  N  S  i  i 

away  withoul  bcin^  strenj^thcncf]  and  helped.  The  Doctor 
listened  to  all  these  problems  with  an  unhurried  interest 
and  a  calm  reassurance.  In  some  way  he  was  able  to  keep 
his  mind  and  heart  in  tune  with  the  larger  realities  and 
unfettered  by  the  worries  and  complexities,  by  the  hamper- 
ing, dissipating  Httle  annoyances  that  weaken  and  handicap. 

"Dr.  Favill's  knowledge  as  a  physician,  his  interest  in 
social  affairs,  his  thoroughgoing  humanity,  his  friendship 
with  people,  running  through  the  whole  gamut  of  our  social 
life,  and  perhaps  more  than  anything  else  his  absolute 
refusal  to  be  fettered  by  the  turmoil  and  perplexities  of  our 
modern  life,  made  him  a  man  of  singular  ability  to  serve. 
His  power  in  this  direction  was  noted  and  often  com- 
mented upon.  His  addresses  on  such  subjects  as  'The 
Police  Power,'  made  in  Washington  at  the  time  of  the 
International  Tuberculosis  Conference,  on  the  'Cause  of 
Child  Labor,'  'Social  Insurance,'  'The  Public  and  the 
Medical  Profession,'  are  evidences  of  his  grasp  and  interest 
in  the  larger  phases  of  social  problems. 

"His  service  to  individuals,  both  the  humblest  and 
most  obscure  and  those  also  of  the  largest  social  and  indus- 
trial standing  of  our  community,  and  in  the  country,  are 
indications  of  the  wide  range  and  grasp  of  the  Doctor's 
life  and  influence. 

"The  psalmist  of  old  exclaimed:  'I  will  lift  up  mine 
eyes  unto  the  hills  whence  cometh  my  help.'  Doctor  Favill 
must  have  found  the  secret  of  the  large  ministries  which 
the  open  fields,  the  woods,  the  hills,  can  yield  each  man  who 
understands  and  knows  how  to  use  them. 

"There  never  is  a  time  when  the  loss  of  such  a  man  can 
be  easily  understood  or  endured.  His  loss  just  now  seems 
peculiarly  heavy  when  large-minded,  unselfish  devotion  are 
so  sorely  needed. 

' '  In  dealing  with  his  patients,  the  doctor  brought  to  the 
sick  room  a  strength  and  reassurance,  a  new  courage  for  the 
fight.     He  was  not  stampeded  or  panic-stricken.     He  did 


12  HENRY      BAIRD      FAVILL 

not  cause  the  patient's  temperature  to  rise  or  his  fighting 
qualities  to  waiver  because  of  any  breathlessness  or  false 
motions  on  his  own  part.  He  breathed  courage  and  hope. 
He  was  a  mighty  rock  of  strength.  Those  very  same 
qualities  the  Doctor  brought  to  boards  of  directors  and 
individual  workers  in  their  troubles  and  problems.  He 
was  able  always  to  make  people  do  their  best  and  to  impart 
new  courage  and  new  hope. 

"Those  of  us  who  knew  the  Doctor's  spirit  of  good  cheer 
and  who  knew  his  friendship  and  caught  the  inspiration  of 
his  radiant,  splendid  spirit,  will  never  forget  him.  He  was 
a  leader  who  inspired  confidence  and  courage  and  joy  of 
service.  We  can  honor  such  a  man  only  by  trying  to  carry 
on  the  kind  of  life  he  lived.  When  Elijah  of  old,  prophet 
and  warrior,  knew  that  the  time  of  his  departing  was  near 
at  hand,  he  said  to  Elisha,  the  man  who  was  to  follow  him, 
'Ask  whatsoever  you  will  and  it  shall  be  granted.'  Elisha' s 
reply  was :  '  I  pray  thee,  that  a  double  portion  of  thy  spirit 
descend  upon  me.'  Our  city,  our  State,  our  country  need 
a  baptism  of  such  spirit,  such  ability  as  that  lived  among 
us  by  our  dear  friend,  Dr.  Favill.  This  same  narrative  to 
which  I  have  referred  goes  on  to  say:  'And  Elisha  took 
up  the  mantle  which  Elijah  laid  down.'  Shall  not  thousands 
among  us  strive  harder  for  the  bigger,  richer  life  because  we 
knew  him?" 

President  Pond:  "Doctor  Favill  was  an  all-round 
man.  He  had,  too,  in  a  high  degree  that  quality  which  the 
ancient  Romans  called  magnanimity,  great-mindedness. 
He  was  a  high-hearted  human  being,  adapted  for  all  expres- 
sions of  life;  a  friend  as  well  as  a  working  man.  It  is  with 
this  all  inclusive  aspect  of  Dr.  Favill's  life  that  Mr.  Frank 
H.  Scott  will  deal." 

FRANK    H.    SCOTT 

"Harry  Favill  was  one  of  nature's  masterpieces.  Inti- 
mate acquaintance  was  not  necessary  to  a  recognition  of  his 


T  R  I  B  II  T  K  S      A  N  [)      I^  I ".  S  O  T.  I J  T  I  O  N  S  13 

distinction.  There,  was  llirit  in  his  features,  the  lineaments 
of  hivS  countenance,  his  form  and  bearing,  which  set  him 
apart  from  other  men,  and  stirred  deeply  the  imagination. 

"In  physical  appearance  he  seemed  of  another  age,  an 
age  more  virile  and  heroic,  who  by  some  chance  had  strayed 
out  of  his  own  time  and  natural  environment,  into  our  own 
commonplace  day,  and  the  conventional  life  of  a  great 
modern  city. 

' '  There  was  revealed  in  his  face  a  calm  confidence  which 
stamped  him  as  a  master  of  circumstances,  never  their 
creature.  That  our  eyes  shall  never  be  gladdened  again 
by  the  sight  of  that  man,  so  exceptional  in  his  physical 
attributes,  is  in  itself  no  little  loss. 

"But  it  was  the  knowledge  that  we  had  of  the  spirit 
within,  which  caused  the  peculiar  shock  which  his  death 
wrought;  for  the  spirit  of  the  man  was  as  rare  as  the  form 
which  embodied  it.  We  have  heard  to-day  of  his  activities 
in  his  profession,  in  civic  affairs,  and  in  the  care  of  the  poor 
and  the  afflicted.  They  were  only  the  more  obvious  mani- 
festations of  an  unremitting,  but  not  vocal,  sympathy  for 
his  fellow  men.  At  the  bottom  of  it  all  was  this  fact,  he 
was  a  rare  friend  of  his  fellow  men. 

"He  became  to  many  of  his  patients  much  more  than  a 
minister  to  bodily  ailments.  To  which  of  us  who  knew  him 
did  the  news  of  his  death  not  bring  instant  thought  of  homes 
to  which  his  death  would  mean  not  merely  the  loss  of  a 
physician,  but  of  a  wise  counsellor  in  the  most  intimate 
affairs  of  life.  We  knew  that  it  struck  at  many  as  though 
a  sustaining  prop  had  suddenly  fallen  awa}?"  from  the  struc- 
ture of  their  lives.  They  leaned  upon  his  strength  from  day 
to  day  and  from  year  to  year. 

"His  civic  work  gratified  no  personal  ambition,  nor  did 
he  find  in  it  any  of  the  excitement  of  the  game.  It  was  a 
burden  assumed  by  an  overburdened  man,  because  of  his 
desire  to  serve  his  fellow  men,  and  to  better  the  conditions 
under  which  they  lived.     He  brought  to  it  a  courage  which 


14  HENRY     BAIRD     FAVILL 

took  no  note  of  consequences  to,  or  criticism  of,  himself. 
He  looked  to  his  own  conscience  for  the  justification  of  his 
acts,  and  finding  it  there,  was  not  fretted  by  the  judgment 
of  others. 

"But  various  as  were  his  activities,  as  publicly  known, 
they  were  by  no  means  the  full  measure  of  his  service.  The 
door  of  this  friend  of  mankind  was  open,  and  his  wisdom 
and  scientific  attainments  were  at  the  service  of  all  who 
came  to  him,  however  humble. 

"His  interest  in  young  men  was  keen,  and  he  found 
time  to  manifest  it  in  ways  that  to  most  busy  men  would 
seem  impossible. 

"Favill  found  time  for  the  intimacies  of  private  friend- 
ships. He  was  a  member  of  certain  little  groups  of  men 
which  for  years  have  been  accustomed  to  meet  at  stated 
periods,  when  the  serious  things  of  life  were,  for  the  most 
part,  thrown  aside,  and  where  the  assured  confidence  of 
mutual  respect  and  affection  made  possible  the  freest  inter- 
change of  give  and  take,  of  raillery  and  wit,  and  on  such 
occasions  none  struck  keener  blows,  or  took  them  with  better 
grace  than  did  he.     He  was  born  for  friendship. 

"Often  I  have  wondered  how  Favill  accomplished  so 
many  and  such  different  things,  and  indeed,  why  he  under- 
took so  much  outside  of  the  profession  which  itself  imposed 
such  burdens  upon  him.  The  answer  came  in  the  funeral 
service.  You  will  remember  that  Dr.  Gunsaulus  told  of 
an  occasion  when  Dr.  Favill  addressed  the  Young  Women's 
Christian  Association,  and  opening  the  Bible  read  that 
chapter  beginning:  'Although  I  speak  with  the  tongues  of 
men  and  of  angels,  and  have  not  love,  I  am  become  as  sound- 
ing brass,  or  a  tinkling  cymbal. '  Therein  that  self-contained 
man  revealed  himself  and  explained  his  life.  The  note 
he  struck  that  day  was  the  note  to  which  his  heart  was 
tuned.  His  was  the  great  love  of  one  who  would  lay  down 
his  life  for  his  friend;  he  was  the  friend  of  mankind,  and 
to  the  service  of  mankind  he  devoted  his  life." 


OTHER   MEMORIALS 


BOARD  OF  TRUvSTEES  OF  RUSH  MEDICAL 
COLLEGE 

IN  MEMORIAM  — HENRY  BAIRD  FAVILL,  M.D. 

PROFESSOR  OF  CLINICAL  MEDICINE,   RUSH  MEDICAL  COLLEGE 

IN  the  death  of  Dr.  Henry  Baird  Favill,  Rush  Medical 
College  has  lost  one  of  its  most  distinguished  alumni 
and  faculty  members.  He  graduated  from  the  College, 
February,  1883,  and  became  a  member  of  its  faculty,  as 
adjunct  Professor  of  Medicine,  in  1895,  which  position  he 
occupied  until,  in  1898,  he  was  made  Ingals  Professor  of 
Therapeutics,  a  chair  endowed  by  the  late  Dr.  Ephraim 
Ingals.  In  1906,  finding  that  his  lecture  work  in  therapeu- 
tics consumed  more  time  than  he  was  able  to  give  to  it,  he 
resigned  this  chair,  and  was  made  Professor  of  Clinical 
Medicine,  offering  thereafter  a  clinical  course  during  a  part 
of  each  year  at  St.  Luke's  Hospital. 

Dr.  Favill  was  born  in  Madison,  Wis.,  August  14,  i860. 
He  was  always  an  earnest  student  of  heredity,  and  his  own 
physical  and  mental  characteristics  afford  an  interesting 
illustration  of  the  laws  of  inheritance.  His  father,  one  of 
the  strong  men  in  the  first  generation  of  physicians  in 
Wisconsin,  after  its  admission  to  statehood,  possessed  the 
powers  of  keen,  accurate  observation,  sound  judgment, 
and  the  uncompromising  hatred  of  all  pretense  and  sham, 
which  were  so  characteristic  of  the  son.  With  this  hatred 
of  sham,  however,  there  was  mingled  in  the  father  a  some- 
what cynical  attitude,  which  was  tempered  in  the  son  by 
the  gentle,  gracious  kindliness  of  a  beautiful  mother.  In 
his  physique  Dr.  Favill  was  an  interesting  example  of 
atavism  —  his  tall,  erect  figure,  free  swinging  gait,  and  his 

15 


i6  HENRY     BAIRD     FAVILL 

facial  contour  presenting  the  characteristics  of  his  Indian 
forebears,  of  whom  he  was  very  proud,  much  more  strikingly 
than  they  were  to  be  seen  in  either  his  mother  or  grand- 
mother, through  whom  he  traced  his  descent  from  Kewino- 
quot,  a  chief  of  the  Ottawa  tribe. 

Environment  and  training  played  an  important  role  in 
his  development.  The  beautiful  "city  of  the  lakes,"  where 
his  youth  was  spent,  offered  abundant  opportunity  and  in- 
ducement for  fishing,  hunting,  boating  and  the  like,  and 
in  these  he  cultivated  that  love  of  out-of-door  life,  which 
was  one  of  the  important  tenets  of  his  medical  philosophy, 
and  which  he  exemplified  in  his  personal  habits  throughout 
his  life. 

Completing  his  preparation  for  college  in  the  Madison 
public  schools,  he  entered  the  University  of  Wisconsin  at 
the  early  age  of  sixteen,  and  graduated  therefrom  with  the 
degree  of  A.B.  in  1880,  three  months  before  his  twentieth 
birthday. 

He  was  not  an  especially  bookish  student,  but  he  was 
keenly  alert  in  class  room  and  laboratory,  and  he  carried 
away  from  his  college  course  a  much  larger  fund  of  use- 
ful, well-digested  information,  and  secured  from  it  a  more 
effective  training  of  his  faculties  than  do  most  students. 
He  was  fortunate,  too,  in  the  circle  of  friends  and  intimates 
of  the  family  —  a  cultured,  high-minded  group,  association 
and  conversation  with  whom  was  in  itself  a  liberal  education. 
In  the  student  body  of  less  than  four  hundred  he  was  a 
prime  favorite,  active  in  the  happy,  care-free  college  life 
of  that  day. 

To  John  Bascom,  president  of  the  University  of  Wis- 
consin in  those  years,  and  one  of  the  great  moral  forces  of 
his  time,  he  attributed  much  of  the  inspiration  to  high  ideals 
of  life  and  the  service  of  humanity,  which  marked  his  later 
years. 

About  the  time  he  entered  Rush  Medical  College,  in 
the  autumn  of  1880,  his  father  developed  cataract,  which 


T  R  I  lU  J  T  !<:  S      ANT)      R  Iv  S  O  I.  I  [  T  I  O  N  S  [7 

threatened  blindness,  and  Henry  Favill  realized  that  the 
burden  of  caring  for  the  family  was  soon  to  fall  on  his 
shoulders.  He  set  about  resolutely  to  fit  himself  for  the 
praetiee  of  medicine,  and  embraced  every  opportunity  to 
acquire  the  necessary  training.  Opportunities  for  practical 
work  were  very  limited  in  the  medical  curriculum  of  that 
day,  and  he  eagerly  accepted  the  position  of  prosector  to 
the  late  Professor  Parkes,  who  held  the  chair  of  Anatomy, 
and  for  two  years  assisted  in  the  preparation  of  the  cadavers 
used  for  demonstration  in  the  lectures  on  Anatomy.  He 
found  opportunity  also  to  acquire  experience  at  the  bedside 
by  relieving  the  interns  at  the  Cook  County  Hospital  and 
St.  Luke's  Hospital  in  their  vacation  periods.  Graduating 
in  1883,  he  returned  to  Madison,  and  entered  into  practice 
with  his  father.  He  thus  found  at  once  a  considerable 
clientele,  which  rapidly  grew,  and  in  a  few  months  he  was 
immersed  in  a  large  and  exacting  practice. 

In  1888,  when  the  death  of  the  Professor  of  Surgery  in 
Rush  Medical  College,  the  distinguished  Moses  Gunn, 
led  to  the  promotion  of  Professor  Parkes  to  that  chair, 
and  the  calling  of  Dr.  Bevan  to  the  chair  of  Anatomy,  he 
was  offered  the  position  of  Demonstrator  of  Anatomy,  but 
he  did  not  feel  that  he  could  leave  his  established  practice 
in  Madison  at  that  time.  Moreover,  his  inclination  was 
never  toward  the  practice  of  surgery,  to  which,  in  those 
days,  the  teaching  of  Anatomy  was  presumed  to  lead,  and 
so  he  declined  the  position  and  recommended  a  fellow 
student  of  his  college  days.  In  1894,  yielding  to  the 
urgent  persuasion  of  some  of  his  friends  in  Chicago,  who 
had  long  felt  that  so  strong  a  man  should  be  at  work  in  a 
larger  field,  he  came  to  Chicago  and  entered  into  a  general 
practice.  The  conditions  on  the  north  side,  where  he  estab- 
lished himself,  were  ripe  for  the  advent  of  such  a  physician, 
and  in  a  remarkabty  short  time  he  was  in  command  of  a 
large  practice  among  people  who  appreciated  thoroughly 
the  efficient,  conscientious  service  which  he  rendered  them. 


i8  HENRY     BAIRD     FA  V  ILL 

Few  men  have  been  more  highly  endowed  with  all  the 
requisite  qualifications  for  general  practice,  and  fewer  still 
have  made  such  splendid  use  of  them  as  Dr.  Favill.  His 
commanding  physique,  his  cheerful  manner  and  keen  sense 
of  humor,  his  unremitting,  conscientious  devotion  to  his 
patients,  and  his  large  fund  of  sound  common  sense,  inspired 
confidence  at  once  when  he  entered  the  sick  room.  Not 
only  did  he  command  the  confidence  of  his  large  and  influ- 
ential clientele  as  their  family  physician,  but  impressed 
with  the  soundness  of  his  judgment,  his  absolute  integrity, 
his  high  ideals  and  his  breadth  of  view,  they  were,  in  later 
years,  glad  to  be  guided  by  his  advice  in  supporting  meas- 
ures for  the  public  weal,  and  so  to  become  co-workers  with 
him  in  such  important  movements  as  the  anti-tuberculosis 
crusade. 

As  a  lecturer  and  writer,  Dr.  Favill,  in  his  earlier  years, 
had  sometimes  a  rather  involved  style.  In  the  correction 
of  this  he  resolutely  schooled  himself  and  in  time  became 
one  of  the  most  forceful  and  effective  speakers,  especially 
to  a  non-medical  audience. 

Dr.  Favill's  largest  service  was  rendered  in  the  last 
decade  of  his  life,  as  an  active  participant  and  leader  in 
movements  for  the  public  good,  both  medical  and  otherwise. 

This  phase  of  his  activities  seems  to  have  been  entered 
upon  definitely,  when  he  became  one  of  the  founders  of  the 
Chicago  anti-tuberculosis  organization.  He  was,  for  most 
of  the  time,  antedating  the  taking  over  of  the  work  by  the 
city  of  Chicago,  its  president,  and  the  funds  for  its  main- 
tenance were  largely  secured  by  him.  How  efficient  was 
this  service  is  evidenced  by  the  present  magnitude  of  Chi- 
cago's anti-tuberculosis  organization. 

In  the  City  Club,  of  which  he  was  a  charter  member 
and  one  of  its  first  presidents.  Dr.  Favill  found  a  congenial 
field  of  activity,  and  was  a  large  factor  in  making  of  it  one 
of  the  most  useful  agencies  for  good  that  Chicago  has  known. 
His  interest  in  civic  affairs  in  this  club  led  to  his  selection 


TRirMJTICS      AND      R  I<:  S  O  [.  11  T  I  O  N  S  19 

as  president  of  the  Municipal  Voters'  League,  whieh  has 
done  so  much  to  purge  the  City  Council  of  the  "gray 
wolves"  that  have  infested  it.  The  important  duties  of 
this  position  were  not  to  be  discharged  without  opposition 
and  the  estrangement  of  some  strong  influential  patrons, 
but  he  swerved  not  an  iota  in  the  courageous  discharge  of 
its  duties  as  he  saw  them. 

Of  the  many  other  movements  to  which  he  gave  of  his 
time  and  strength,  it  is  not  possible  to  speak  in  this  brief 
sketch,  excepting  of  the  one  which  gave  him  the  largest 
scope  and  brought  him  into  national  prominence.  In  19 10 
the  American  Medical  Association  created  the  Council  on 
Health  and  Public  Instruction,  whose  function  it  is  to  pro- 
mote the  education  and  advance  the  interests  of  the  public 
along  health  lines.  Almost  from  its  creation  he  was  chair- 
man of  the  Council,  and  it  is  doubtful  if  any  man  in  the 
medical  profession  could  have  directed  its  activities  as 
sanely  and  effectively  as  did  Dr.  Favill.  Wisely  keeping 
the  Council  out  of  all  participation  in  political  activity,  and 
holding  it  firmly  to  the  line  of  an  educational  propaganda, 
and  seeking  the  fullest  and  most  effective  cooperation 
with  other  national  organizations  having  purposes  in  com- 
mon, he  was  largely  instrumental  in  making  the  Council 
one  of  the  strongest,  most  productive  agencies  for  good 
in  the  field  of  public  health.  Dr.  Favill  saw  much  more 
clearly  than  most  physicians  the  strong,  steady  trend  of 
medicine  in  the  direction  of  preventive  as  contrasted  with 
curative  medicine,  and  the  large  part  which  sociologic  prin- 
ciples and  methods  must  pla^?"  in  its  development.  He 
believed  that  this  development  must  come  almost  wholly 
through  the  universal  education  of  the  people,  and  that 
only  on  the  basis  of  a  widespread  understanding  of  the 
possibilities  and  essential  requisites  of  hygiene  and  sani- 
tation could  effective  legislation  be  secured. 

In  his  direction  of  the  work  of  the  Council  he  displayed 
rare  administrative  and  executive  abilitv.     Unvielding  in 


20  HENRY     BAIRD     FAVILL 

his  fight  for  basic  principles,  but  tactful  and  receptive  in 
the  discussion  of  details  of  plans  and  methods,  he  had  a 
keen  sense  of  discrimination  and  proportion  in  distinguishing 
the  essential  from  the  non-essential  points  under  discussion. 
He  left  the  details  of  the  work  in  hand  to  those  assigned 
to  that  task,  and  when  these  were  ready  for  presentation 
he  was  a  prince  of  listeners.  Tilted  back  in  his  chair,  his 
fine  head  thrown  far  back  resting  on  his  clasped  hands, 
and  his  gaze  fixed  on  the  ceiling,  he  would  listen  attentively 
to  a  detailed  statement  of  the  items  to  be  considered  and 
maybe  a  protracted  discussion  —  and  then  go  direct  to  the 
core  of  the  matter  and  set  forth  the  real  essentials  in  a 
brief,  clear,  logical  statement. 

The  wide  scope  of  his  interests  is  well  exemplified  by 
his  election  as  president  of  the  National  Dairy  Council 
the  year  before  his  death.  For  him  the  breeding  of 
dairy  stock  was  an  avocation  —  a  diversion  incidental  to 
an  intensely  busy  life  in  lines  far  remote.  And  yet  so  live 
was  his  interest  in  it,  so  thorough  his  mastery  of  the  tech- 
nical problems  involved,  he  impressed  this  considerable 
and  important  group  of  men  who  were  devoting  their 
lives  exclusively  to  this  industry  so  strongly,  that  he  was 
recognized  as  a  leader  among  them  in  their  own  line  of 
activity. 

His  professional  attainments  were  abundantly  recog- 
nized by  the  medical  fraternity.  He  was  a  member  of 
many  medical  societies,  local  and  national,  and  an  officer, 
at  one  time  or  another,  in  several. 

He  lived  to  see  his  son,  the  only  child  of  his  union  with 
Susan  Cleveland  Pratt,  to  whom  he  was  married  in  1885, 
graduated  in  arts  from  Yale  University,  in  medicine  from 
Harvard  University,  as  an  intern  in  the  Massachusetts 
General  Hospital,  and  finally  established  in  practice  with 
him  and  following  in  his  footsteps  as  a  teacher  of  medicine 
in  Rush  Medical  College. 

In  recognition  of  the  great  service  of  Henry  Baird  Favill 


T  R  I  ]}  n  T  10  S      AND      R  10  S  D  I.  (F  T  I  O  N  S  2  r 

to  the  people  of  CWm-.i^o  and  of  th(!  nation,  and  of  the 
truly  unique  position  which  he  occupied  in  the  medical 
profession  in  America,  in  grateful  recognition  of  his  service 
to  Rush  Medical  College,  and  of  the  distinction  which  he 
brought  to  it  as  an  alumnus  and  a  member  of  its  faculty, 
the  trustees  and  faculty  spread  this  memorial  sketch  upon 
its  records. 

RESOLUTION   ADOPTED   BY   THE   WISCONSIN 
SOCIETY   OF   CHICAGO 

At  a  Meeting  held  February  21,   1916 
IN    MEMORIAM— HENRY   BAIRD   FAVILL 

ON  the  morning  of  February  20,  1916,  Death  sum- 
moned our  brother,  Henry  Baird  Favill,  to  the 
immortal  life   in   the   Great   Beyond. 

In  the  full  flush  of  vigorous  manhood,  happy  in  the 
employment  of  a  magnificent  physique  and  a  splendid 
mental  power  for  the  benefit  of  his  fellow  men,  with  char- 
acteristic fearless  dignity,  he  expressed  his  preparedness 
to  meet  the  unexpected  command,  in  these  words:  "If  I 
am  called,  it  will  be  all  right." 

Born  at  Madison,  Wis.,  on  August  14,  i860,  he  inherited 
the  virile  mental  and  physical  characteristics  of  splendid 
ancestors.  From  his  father,  Dr.  John  Favill,  a  love  of 
science  and  a  dislike  of  hypocrisy  and  sham;  from  his 
mother  a  mental  and  ph3^sical  fibre  which  distinguished 
him  among  men.  Reared  in  an  environment  of  refine- 
ment and  the  atmosphere  of  culture  of  a  university  city, 
he  developed  those  rare  qualities  of  mind  and  heart  which 
awakened  respect  in  all  who  came  in  contact  with  him. 
His  friends  were  numberless  and  those  favored  with  inti- 
mate association  loved  him. 

Before  he  was  twenty-three  years  of  age,  he  was  pre- 
pared for  life's  work  by  the  classical  course  at  the  University 
of  Wisconsin  and  medical  study  for  three  3'ears  in  Rush 


22  HENRY     BAIRD     FAVILL 

Medical  College.  The  severe  illness  of  his  father  compelled 
him  to  immediately  assume  the  double  burden  of  respon- 
sibility of  the  care  of  the  family  and  of  his  father's  med- 
ical practice.  Young  and  inexperienced,  he  proved  his 
qualifications  and  character  by  successfully  meeting  every 
obligation. 

For  thirty-three  years  Henry  Favill  enjoyed  as  few  men 
do  the  arduous  toil  of  a  successful  physician.  As  a  family 
doctor  he  aroused  the  confidence  of  patient  and  friends 
in  his  ability  to  apply  all  the  knowledge  which  modern 
medicine  affords,  in  the  recognition  of  the  cause  of  disease 
and  in  the  application  of  rational  measures  to  the  pro- 
longation of  life  and  the  relief  of  suffering.  To  many  he 
was  more  than  physician;  for  he  helped  them  to  solve  the 
many  problems  which  vex  the  mind,  by  a  judgment  as 
rare  as  that  of  a  Solomon.  He  enjoyed  the  respect  of  the 
members  of  the  medical  profession,  who  added  to  his  burdens 
by  demanding  his  aid  in  the  diagnosis  and  management 
of  obscure  and  severe  diseases.  He  justified  the  confidence 
of  patients  and  physicians  alike,  because  of  the  honest 
expression  of  his  opinion  and  the  frank  acknowledgment 
of  his  inability,  in  rare  instances,  to  recognize  obscure 
disease  conditions. 

He  affiliated  with  local,  State,  and  National  medical 
organizations  and  took  an  active  part  in  the  scientific 
proceedings.  By  members  of  the  medical  profession  of 
the  whole  country  he  was  known  as  one  who  possessed  a 
profound  knowledge  of  medicine  and  all  that  pertains  to  it, 
and  he  was  noted  as  one  whose  horizon  was  big  and  broad 
in  regard  to  all  the  problems  of  life.  Early  in  his  career 
he  recognized  the  importance  of  preventive  medicine.  To 
the  study  of  these  problems  he  devoted  much  time  with 
gratifying  practical  results.  As  the  chairman  of  the  Council 
on  Health  and  Public  Instruction  of  the  American  Medical 
Association,  he  developed  and  organized  a  method  of  coop- 
eration of  hundreds  of  organizations,  in  the  various  fields 


TRiniJTTCS      AND      R  1<:  S  O  I.  IT  T  T  O  N  S  23 

of  health  betterment  work,  which  will  ;ilways  be  a  credit 
to  hi.s  masterful  mind  and  rare  judgment. 

For  twenty  years,  the  best  of  his  life,  he  lived  and 
worked  for  the  people  of  Chicago.  In  sj)ite  of  the  enor- 
mous work  in  private  and  hospital  practice,  he  took  the 
time  necessary  to  make  his  influence  felt  in  social  service 
and  civic  life.  As  president  of  the  City  Club  he  helped  to 
mould  its  policies  and  to  make  it  a  potent  influence  for  good 
in  Chicago  and  elsewhere.  As  president  of  the  Municipal 
Voters'  League  he  fought  political  spoilsmen  to  a  finish, 
disregarding  the  enmities  aroused  among  wrong-doers  and 
unmindful  of  the  plaudits  of  others,  in  the  fulfilment  of 
his  ideas  of  the  duties  of  a  citizen. 

But  Henry  Baird  Favill  did  not  spend  all  of  his  time  in 
work.  He  enjoyed  the  society  of  friends.  He  loved  books 
and  music  and  artistic  things.  But  above  all  he  loved 
the  sky,  the  mountains  and  canyons,  the  hills  and  valleys, 
the  woods  and  streams,  and  all  living  things  both  tame  and 
wild.  Perhaps  he  inherited  from  a  maternal  grandfather, 
Kewinoquot,  a  chief  of  the  Ottawa  tribe,  his  love  of  nature 
as  well  as  the  distinct  magnificent  physique  of  his  American 
ancestor.  His  domestic  life  was  continuously  blessed  by 
the  devotion  of  Susan  Cleveland  Pratt,  whom  he  married 
in  1885.  One  son,  John  Favill,  was  born  to  them.  This 
son,  the  pride  of  his  life,  followed  the  paternal  line  of 
ancestors  and  is  a  successful  practicing  physician. 

Henry  Baird  Favill,  our  friend  in  sickness  and  health; 
our  co-worker  in  social  service  and  civic  duty ;  our  colleague 
in  social  and  scientific  communion  and  our  playfellow  in 
the  woods  and  streams,  we  shall  miss  the  stalwart  form,  the 
smiling  hearty  greeting,  the  ready  wit,  the  fine  mental 
poise  and  sound  judgment  and  the  true  friendship  which 
you  gave  us. 

We  shall  carry  Henry  Favill  in  our  hearts  and  minds 
forever,  but  that  those  who  come  after  us,  as  members  of 
the  Wisconsin  Society  of  Chicago,  may  know  of  our  respect 


24  HENRY      BAIRD      FA  V  ILL 

and  love  for  him,  we  shall  spread  these  words  upon  the 
records  of  the  society. 

(Committee)    Horace  Kent  Tenney 
Horace  A.  Oakley 
Samuel  Fallows 
Frank  Billings,  Chairman 


RESOLUTION  ADOPTED  AT  THE  247TH  REGULAR 

MEETING   OF   THE    COMMERCIAL   CLUB 

OF   CHICAGO,  MARCH  ii,  191 6 

HENRY  BAIRD  FAVILL 

August  14,  i860  —  February  20,  1916 

DR.  HENRY  BAIRD  FAVILL  was  the  only  man 
ever  elected  to  the  Commercial  Club  without  com- 
mercial connections  in  Chicago.  It  was  a  unique 
distinction,  given  and  received.  He  had  won  the  highest 
honors  of  the  medical  profession,  but  this  club  sought 
him  because  of  his  service  to  the  physical  and  moral  health 
—  the  political,  humanitarian,  and  educational  life  —  of 
Chicago. 

Tall,  straight,  sinewy,  with  head  held  high,  he  was 
brother  to  his  native  pines  and  spruces.  His  striking, 
impressive  personality  expressed,  while  it  accentuated,  his 
exceptional  strength,  poise,  sagacity,  and  kindliness.  We 
have  hardly  among  us  another  such  powerful,  definite,  and 
rare  individuality.  He  was  picturesque,  yet  free  from 
eccentricity.  He  did  much  to  develop,  he  did  nothing  to 
emphasize,  the  advantages  which  nature  gave  him. 

He  had  a  confident  strength  and  freedom  and  courage 
of  mind  and  spirit  as  well,  as  of  body.  In  office  and  hospi- 
tal and  medical  class-room,  in  the  Municipal  Voters'  League 
and  its  city  campaigns,  in  the  civic  enterprises  of  the  City 


T  R  I  B  U  T  ]-:  S      AND      R  I<:  S  f )  F.  U  T  I  O  N  S  25 

Club,  in  the  j^rcat  war  aj^'ainsl  tuberculosis,  in  the  beautiful 
organized  efforts  to  save  children — he  was  conspicuous 
only  because  he  was  so  constantly  devoted  and  helpful. 
In  the  multitude  of  his  human  ministrations  he  moved  with 
a  vital  joyousness  and  hope,  a  quiet  energy,  directness,  and 
effectiveness. 

Though  ready  and  expert  of  speech,  and  very  democratic 
and  approachable,  in  an  unusual  way  and  to  a  remarkable 
degree,  he  let  what  he  did  tell  of  itself  and  him.  His  seemed 
to  have  been  a  mind  —  was  it  his  Indian  blood  or  his  con- 
scious will?  —  that  reported  not  its  processes  and  activities 
but  only  its  conclusions.  It  was  his  habit  to  make  his 
tongue  wait  upon  his  mind,  and  to  make  both  servants  of 
the  truth.  He  confessed  ignorance,  and  stated  well-founded 
opinions  or  convictions,  in  the  same  modest  tones  of  candor. 
The  one  called  forth  implicit  trust  in  him  as  strongly  as  the 
other. 

His  face  never  quite  lost  the  look  of  farseeingness  and 
of  high  thinking.  His  were  the  face  and  eyes  of  an  intel- 
lectual mariner,  or  coureur  du  hois,  who  loved  the  journey, 
whatever  befell,  and  meant  to  see  its  beauties  and  its 
dangers  fully.  He  was  no  dreamer  or  visionary,  but  a  very 
practical  idealist,  earnestly  intent  on  present  human 
problems.  Seeing  so  much  the  seamy  side  of  life  only 
widened  his  sympathy  and  increased  his  desire  to  do  a  man's 
part  in  human  betterment.  Thus,  without  showing  by 
word  or  act  that  he  cared  for  these  things,  he  won  great 
influence  in  every  group  in  which  he  ever  was,  and  deep 
admiration  and  devotion  and  affection. 

And  so,  as  one  of  many  groups,  the  Commercial  Club 
records  its  sense  of  the  city's  loss  of  a  chief  citizen,  of  the 
community's  loss  of  a  generous  helper,  and  of  our  own 
irreparable  loss  of  an  inspiring  associate  and  beloved  friend. 
Grieving  that  he  was  taken  in  his  prime,  we  yet  rejoice  in 
the  victorious  life  that  he  led,  in  all  that  it  was,  and  in  the 


26  HENRY      BAIRD     FAVILL 

memory  of  it  that  long  shall  be.     We  must  reverence  human 
life  since  it  bears  such  fruitage. 

(Committee)     Edgar  A.  Bancroft 

Cyrus  H.  McCormick 
Allen  B.  Pond 
John  W.  Scott,  President 
Louis   A.    Seeberger,    Secretary 

RESOLUTION    ADOPTED    BY    THE    COUNCIL    OF 
THE   CHICAGO   MEDICAL  SOCIETY 

March  14,  1916 

HENRY  BAIRD  FAVILL,  long  an  honored  and  valued 
member  of  the  Chicago  Medical  Society,  has  passed 
from  among  us.  He  was  a  loyal  member,  a  strong 
councilor,  an  important  presiding  officer,  a  worthy  antag- 
onist, and  a  staunch  friend.  He  was  a  public  benefactor, 
a  hard  worker  for  the  public  good,  powerful  for  what  he 
thought  the  best,  tolerant  of  honest  opponents  in  discussion 
and  debate;  verily  a  true  and  gentle  knight. 

The  Council  of  the  Chicago  Medical  Society  wishes  to 
express  the  general  grief  at  his  death  and  to  convey  the 
sympathy  of  its  members  and  of  the  members  of  the  Society 
to  the  family  of  our  colleague. 

RESOLUTION   ADOPTED   BY   THE   CHICAGO 
PATHOLOGICAL   SOCIETY 

April  10,  1916 

THE  Chicago  Pathological  Society  deeply  feels  the  loss 
sustained   in  the  death  of  its  fellow  member.   Dr. 
Henry  Baird  Favill,  and  expresses  its  most  grateful 
appreciation  of  the  memory  of  his  magnificent  personality 
and  aggressive  humanity. 

John  Milton  Dodson,  President 
George  H.  Weaver,  Secretary 


TRIBUTES      AND      IMC  S  O  L  L'  T  I  O  N  S  27 


RESOLUTION    ADOPTED    BY   THE   TRUSTEES   OF 

THE  ELIZABETH  McCORMICK 

MEMORIAL  FUND 

THE  surviving  trustees  of  the  Elizabeth  McCormick 
Memorial  Fund  desire  to  enter  upon  the  record  of 
their  proceedings  an  expression  of  their  sorrow  at 
the  death  of  their  associate,  Dr.  Henry  B.  Favill,  and  of 
their  sense  of  the  great  loss  which  the  Fund  has  suffered 
in  his  death.  From  the  time  of  its  establishment  to  his 
death  he  brought  to  the  service  of  the  Fund  a  rare  knowledge 
of  the  field  covered  by  its  operations,  and  a  sanity  of  judg- 
ment which  led  his  associates  to  lean  more  and  more  upon 
him  as  time  passed  and  to  follow  his  lead  with  implicit  trust 
and  confidence. 

The  reserved  composure  of  his  countenance  and  manner 
was  doubtless  but  a  faithful  reflex  of  one  phase  of  his  char- 
acter which  made  him  the  strong  self-reliant  man  that  he 
was.  But  his  associates  in  those  activities  of  his  life  which 
were  directed  toward  social  amelioration  and  especially 
toward  child  welfare,  were  not  slow  to  discover  that  coupled 
with  an  austere  self-control  there  was  in  him  a  pity  for 
the  weak,  the  helpless,  and  the  suffering,  that  had  the 
depth  and  force  of  a  passion.  And  as  if  to  complete  his 
endowment  for  work  of  the  kind  which  the  Fund  has  under- 
taken, he  had  the  insight,  so  rarely  coupled  with  that  sense 
of  pity,  to  see  clearly  the  dangers  that  attend  indulgence 
in  unrestrained,  indiscriminate  pity. 

The  loss  to  the  Fund  of  a  trustee  so  endowed  is  an 
irreparable  loss. 


28  HENRY      BAIRD     FAVILL 


RESOLUTION   ADOPTED   BY   THE   BOARD   OF 

DIRECTORS  OF  THE 

NATIONAL  DAIRY  COUNCIL 

At  a  Special  Meeting  held  February  28,   1916 

IN  the  death  of  Henry  Baird  Favill  the  National  Dairy 
Council  loses  its  president  and  the  dairy  world  one  of 
its  most  loyal,  most  devoted,  and  most  efficient  factors. 
Lamenting  their  losses  with  a  grief  that  is  personal  and 
a  full  appreciation  of  their  disastrous  effect  upon  the  dairy 
industry,  the  members  of  the  National  Dairy  Council  thus 
formally  express  to  the  family  of  Dr.  Favill  their  deepest 
sympathy  and  their  keen  sense  of  appreciation  of  his 
devoted  and  distinguished  services  for  the  advancement 
of  the  dairy  industry. 

(Directors) 

W.  W.  Marsh  John  LeFeber 

M.  D.  MuNN  H.  S.  Early 

H.  O.  Alexander  W.  J.  Kittle 

H.  B.  Osgood  Walter  West 

John  W.  Kobbe  H.   Brown   Richardson 

George  E.  Haskell  O.  F.  Hunzicker 

J.  J.  Farrell  H.  a.  Harding 

LoTON  Horton  W.  E.  Skinner,  Secretary 


RESOLUTION   ADOPTED   BY   THE   HOLSTEIN- 
FRIESIAN    ASSOCIATION  OF  AMERICA 

June  7,  1916 

DR.  HENRY  B.  FAVILL  became  a  member  of  the 
Holstein-Friesian  Association  of  America  on  Decem- 
ber  16,   1 910.     He  was   then  engaged  in  breeding 
purebred   Holstein-Friesians   on   his   farm   at    Lake    Mills, 


T  R  I  n  U  T  IC  S      AN  I)      R  K  S  O  T.  U  T  I  O  N  S  29 

Wis.,  and  practicinj.^  his  profession  in  Chicago,  and  had 
become  well  known  to  our  members  throughout  the  Middle 
West.  Upon  the  occasion  of  our  annual  meeting  at  Syra- 
cuse, N.  Y.,  in  June,  191 1,  Dr.  Favill  made  an  address 
upon  the  subject  of  tuberculosis  in  cattle.  It  was  at  this 
time  that  the  outstanding  ability  and  greatness  of  the  man 
were  impressed  upon  our  membership,  and  those  who  lis- 
tened to  his  thorough  and  practical  exposition  of  this  most 
perplexing  subject  and  its  relationship  to  the  cattle  industry 
recognized  that  a  master  mind  had  spoken. 

At  the  annual  meeting  of  1914,  held  at  Chicago,  he  was 
unanimously  called  to  accept  -the  vice-presidency  of  the 
Association,  and  had  served  continuously  thereafter  up  to 
the  time  of  his  demise,  being  conscientiously  in  attendance 
upon  every  meeting,  whether  of  the  directors  or  of  mem- 
bers, contributing  generously  of  his  valuable  time,  and 
interesting  himself  in  every  detail  of  our  work  and  its 
purposes,  thus  qualifying  himself  to  bring  his  powerful 
mind  to  the  full  consideration  and  understanding  of  our 
problems  and  rendering  invaluable  service  in  their  solution. 

That  he  was  deeply  interested  in  Holstein  cattle  and  in 
the  future  of  our  organization  was  manifest  in  every  way; 
that  he  realized  its  future  was  evidenced  by  his  comments 
and  suggestions  of  a  constructive  character,  and  it  was 
hoped  that  we  might  long  have  his  services.  In  his  loss, 
we,  as  an  organization,  have  suffered  a  great  misfortune. 
Those  who  knew  him  personally  and  realized  his  sym- 
pathy, courteousness,  and  friendship  are  indeed  to  be  con- 
doled with. 

Dr.  Favill's  work  with  our  organization  and  cattle  was 
but  a  minor  matter,  comparatively,  in  his  life.  As  a 
physician  he  was  not  only  of  the  highest  rank  in  this  coun- 
try, but  he  was  also  a  leader  in  co-related  effort  for  the 
public  good  and  worked  assiduously  for  such  safeguards 
of  the  health  of  the  community  as  proper  sanitation,  the 
inspection  of  foods,  and  the  regulation  of  medical  practice. 


30  HENRY      BAIRD     FA  V  ILL 

He  was  deeply  interested  in,  and  sacrificed  much  of  his 
time  and  energy  to,  civic  and  social  conditions  and  the 
improvement  thereof;  and  he  was  a  charter  member  and 
for  two  years  president  of  the  City  Club  of  Chicago, 
an  organization  widely  known  in  connection  with  such 
work. 

He  was  attending  physician  of  St.  Luke's  Hospital  and 
chief  of  its  staff  at  the  time  of  his  death.  For  six  years 
he  was  chairman  of  the  Council  on  Health  and  Public 
Instruction  of  the  American  Medical  Association  and  made 
its  work  of  great  importance  by  cooperating  with,  and 
coordinating  the  functions  =  of,  hundreds  of  organizations 
all  over  the  country  which  were  attempting  to  improve  the 
physical  and  social  conditions  of  mankind.  He  undertook 
the  arduous,  unending,  disturbing,  perilous  work  involved 
in  the  presidency  of  the  Municipal  Voter's  League.  The 
American  Association  of  Labor  Legislation  had  no  more 
wise  or  practically  effective  adviser  than  Dr.  Favill.  He 
was  foremost  in  proposing,  guiding,  and  supporting  the 
Bureau  of  Public  Efficiency  and  thus  applied  intensively 
and  technically  his  knowledge  of  the  science  of  govern- 
ment. In  settlement  work  he  was  much  at  home  as  a 
trustee  of  Chicago  Commons.  His  civic  work  gratified 
no  personal  ambition;  it  was  a  burden  assumed  because  of 
his  desire  to  serve  his  fellow  men.  His  wisdom  and  scien- 
tific attainments  were  at  the  service  of  all  who  came  to  him. 
He  was  the  friend  of  mankind  and  to  the  service  of  mankind 
he  devoted  his  life. 

His  qualities  of  mind  and  heart,  his  rare  judgment,  his 
poise  and  vision,  his  sincerity,  revealed  him  as  a  source 
of  strength  which  was  eagerly  sought  by  organizations 
and  individuals  in  their  big  problems  and  perplexities. 
His  grasp  and  interest  in  the  larger  phases  of  social  prob- 
lems were  evidenced  by  his  addresses  on  such  subjects  as 
the  "Police  Power,"  made  in  Washington  at  the  time  of 
the  International  Tuberculosis  Conference,   and  on  "The 


TRIBUTES      AND      R  !<:  S  O  L  U  T  I  O  N  S  31 

Cause   of   Child   Labor,"    "vSocial    Insurance,"    and   "The 
Public  and  the  Medical  Profession." 

The  .spirit  of  his  ^ood  cheer,  his  radiant  splendid  spirit, 
will  never  be  forj^otten  by  his  personal  friends.  He  was  a 
leader  who  inspired  confidence  and  courage  and  joy  of 
service.  He  was  a  manly  man  of  wonderful  mental  poise, 
unending  optimism,  and  the  gentleness  of  a  woman.  There 
are  those  among  us  who  will  strive  harder  for  the  bigger, 
richer  life  because  we  knew  him. 


RESOLUTION   ADOPTED   BY   THE   SOCIAL 
SERVICE   CLUB 

At  a  Meeting  held  February  21,   1916 
IN  MEMORY  OF  DR.  HENRY  BAIRD  FAVILL 

IN  the  death  of  Dr.  Henry  Baird  Favill  the  Social  Service 
Club,  numbering  more  than  eight  hundred  members, 
and  representing  practically  all  the  charitable  and 
philanthropic  agencies  in  Chicago,  has  lost  a  friend  in 
whom  there  was  a  combination  of  sympathy,  vision,  under- 
standing, and  courage  that  was  rare,  if  not  unique.  His 
splendid  and  commanding  presence  won  immediate  atten- 
tion and  admiration,  and  his  qualities  of  mind  and  heart, 
friendship,  allegiance,  and  respect. 

Dr.  Favill's  services  were  in  demand  by  the  boards  and 
organizations  represented  in  our  club  because  they  recog- 
nized his  leadership  and  ability.  Perhaps  more  than  any 
other  man  in  the  city  he  was  sought  for  by  such  agencies, 
and  by  individuals  as  well,  in  the  big  problems  and  per- 
plexities, and  no  one,  we  believe,  ever  went  to  him  on  such 
quests  without  coming  away  strengthened  and  helped.  He 
listened  to  all  these  problems  with  unhurried  interest  and 
calm  reassurance.  In  some  way  he  kept  his  mind  and  heart 
in  tune  with  realities  and  unfettered  by  worries  and  per- 
plexities, so  that  his  judgment  reflected  the  larger  verities. 


32  HENRY     BAIRD     FA  V  ILL 

Those  who  knew  Dr.  Favill  and  had  the  opportunity 
personally  to  catch  his  spirit  and  joy  of  living  and  serving 
will  never  forget  him.  We  feel  that  he  was  one  of  the  best 
embodiments  of  good  fellowship  and  efficient  citizenship 
we  have  ever  known,  and  that  the  greatest  thing  we  can 
wish  for  ourselves  and  for  our  community  in  trying  to 
honor  him,  is  that  "a  double  portion  of  his  spirit"  may 
dscend  upon  us. 

For  the  Social  Service  Club: 

Sherman  C.  Kingsley 
Helen  M.  Crittenden 
Wilfred  S.  Reynolds 
Adelaide  Mary  Walsh 
Philip  L.  Seman 


A   PERSONAL   TRIBUTE 
By  Cyrus  H.  McCormick 

AS  a  personal  friend  of  Dr.  Favill,  it  is  a  privilege  .to 
pay  his  memory  a  brief  tribute  of  regard,  not  for 
myself  alone,  but  for  all  those  of  the  International 
Harvester  Company  who  had  come  in  contact  with  his 
rare  personality. 

Most  men  who  attain  any  eminence  achieve  it  by  con- 
centration upon  one  interest.  This  man  was  so  big  in  brain, 
heart,  energy,  and  character  that,  in  addition  to  a  remark- 
able professional  career,  he  had  time  and  strength  to  render 
valuable  service  for  the  civic  good  —  to  be  an  uplifting  force 
in  his  community,  giving  royally  of  his  personality  and 
ability.  I  call  to  mind  no  man  using  a  matchless  strength 
of  body  and  mind  and  soul  so  effectively,  so  helpfully,  and 
so  unselfishly. 

Each  one  of  us  whose  life  he  touched  is  grateful  for  the 
memory  of  Henry  Baird  Favill,  skilled  in  healing  human 


T  R  T  TJU  T  E  S      ANT)      K  IC  S  O  L  (J  T  I  O  N  S  33 

ailments,  wise  and  kind  in  comforlinj^  weary  hearts,  inspired 
to  guide  us  through  our  perplexities  —  a  man  whose  life 
and  work  and  character  were  to  all  those  of  his  time  and 
place  like  a  great  light  shining  steadily  from  a  hilltop. 


HENRY  FAVILL  WAS  ONI^  REAL  MAN  —  DOCTOR 
WHO  WAS  EVERYBODY'S  FRIEND 

By  Carl  Sandburg 

I   WANT  to  throw  a  flower  on  a  man's  coffin  to-day 
and  then   go  on  with   my  work.     They   are  burying 

Henry  B.  Favill  and  he's  the  man  I  want  to  remember 
for  to-day. 

There's  a  beauty  about  death  when  it  takes  a  man 
with  a  face  like  that  of  Favill.  He  was  a  white  man  with 
a  strong  dash  of  Indian  blood  in  him.  Or  to  put  it  another 
way,  he  was  an  Indian  with  white  man's  blood.  Anyway, 
his  face  had  the  sad,  stern  power  written  on  faces  of  some 
of  the  finest  Indians  —  the  deep,  quizzical  though tfulness 
of  a  Lincoln  face;  one  of  those  faces  of  power  and  dignity 
even  in  a  varnished  and  nickel-plated  coffin  sold  by  modern 
undertakers. 

Now  the  reason  I  want  to  remember  him  with  a  flower 
to-day  is  because  he  was  a  man  of  light  and  vision.  I 
don't  care  so  much  about  his  record  as  a  leader  in  the 
Municipal  Voters'  League.  What  I  remember  out  of  his 
speech  and  writing  is  that  the  human  body  is  naturally  a 
clean,  sweet,  and  beautiful  thing  of  life.  As  a  physician 
and  as  a  social  scientist,  he  saw  waste  and  wreckage  of 
human  life  in  mills  and  workshops,  in  homes  and  sleeping- 
rooms.  In  a  patient,  quiet,  persistent  way  he  accused  his 
fellow  men  of  doing  wTong  in  allowing  the  long  work  day, 
that  breeds  fatigue  toxins  in  the  blood  of  factory  girls  and 
robs  the  rose  color  from  the  cheeks  and  the  quickness  from 
the  eyes. 

3 


34  HENRY      BAIRD     FA  V  ILL 

He  was  quoted  in  State  legislatures  along  with  Louis 
Brarideis  and  Josephine  Goldmark  as  an  authority  on  night 
work  and  the  long  hours  —  how  they  operate  like  poisons 
and  carry  early  death. 

He  was  a  director  of  the  American  Association  for  Labor 
Legislation  and  an  active  worker  in  the  anti-tuberculosis 
organizations. 

To  him  the  terrible  thing  about  the  white  plague  was 
that  it  is  "preventable."  Plenty  of  fresh  air  in  sleeping- 
rooms,  workshops,  and  street  cars,  plenty  of  good  food  and 
enough  rest  hours  in  the  workday  —  and  there  wouldn't 
be  any  disease  called  consumption,  racking  thirty-five  hun- 
dred people  to  death  every  year  in  Cook  County. 

Favill  was  one  of  the  men  who  started  the  nation-wide 
agitation  for  better  health  fundamentals  in  American  living 
conditions.  Instead  of  "bigger  and  better  business"  he 
was  always  talking  "healthier  and  happier  people." 

I  am  glad  for  a  chance  to  use  his  funeral  as  a  feature 
story  to  speak  the  chief  message  of  his  life,  the  message 
that  his  big  employers,  like  Julius  Rosenwald,  Eddie  Hill- 
man,  and  Charlie  Piez,  have  a  direct  control  over  the  health 
of  the  thousands  working  for  them  through  control  of  the 
air  supply,  the  working  hours,  and  the  wages  that  dictate 
housing  conditions. 

And  I  feel  better  at  throwing  a  sheaf  of  green  leaves 
and  an  American  Beauty  on  the  cofhn  of  Henry  B.  Favill 
to-day  because  in  his  circle  he  was  a  great  and  useful 
agitator  and  teacher. 

TRIBUTE   BY   REV.    DR.    E.    G.   UPDIKE 

DR.  HENRY  BAIRD  FAVILL  is  stricken  in  the  very 
prime  of  his  splendid  manhood.     I  regard  him  as 
one  of  the  very  greatest  men  who  have  gone  out 
from  the  University  of  Wisconsin,  or  who  was  born  and 
reared  in  this  commonwealth.     He  was  great  in  his  physical 


T  R  I  H  1 1  '1'  i:  S      A  N  F)      K  K  SOLUTIONS  35 

manhood,  lie  conini.-mdcd  your  atLcnUon  at  once.  What 
a  body  for  a  great  soul ! 

He  was  great  in  his  profession.  He  worked  with  the 
most  eminent  men  in  the  medical  ])rofession  of  the  nation. 

He  was  greater  th.-m  his  profession.  As  a  publie-spirited 
citizen  he  easily  ranked  with  the  greatest  philanthropists 
and  publicists  of  Chicago. 

There  was  no  good  cause  that  did  not  enlist  his  interest 
and  in  the  most  unselfish  way  he  stood  ready  to  serve  the 
public  on  all  occasions. 

He  was  great  in  the  range  of  his  vision,  in  his  common 
sense,  and  the  almost  instant  ability  which  he  had  to  pro- 
nounce judgment  on  the  most  important  matters  —  judg- 
ment which  seldom  had  to  be  changed. 

He  had  a  vocation  and  an  avocation.  His  avocation 
had  come  to  be  a  matter  of  as  absorbing  interest  as  his  pro- 
fession. He  had  purchased  what  was  originally  his  grand- 
father's farm  at  Lake  Mills,  Wis.  He  had  developed  what 
was  coming  to  be  regarded  as  one  of  the  most  wonderful 
agricultural  plants  in  the  State.  He  had  not  been  reared 
on  the  farm  but  he  loved  it.  He  had  the  spirit  of  the  true 
farmer.  He  mastered  every  detail  and  he  knew  the  name 
and  history  of  every  one  of  the  one  hundred  and  seventy-five 
purebred  cattle  on  his  place.  Nothing  escaped  him.  No 
experiment  station  did  its  work  more  carefully  or  scienti- 
fically than  he.  He  told  me  that  out  of  his  farm  he  was 
getting  an  intellectual  stimulus  equal  to  that  of  his  pro- 
fession. 

All  this  is  but  an  indication  of  the  greatness  of  the  man. 
He  would  have  been  great  anywhere  and  with  almost  any 
kind  of  responsibility  placed  upon  him.  Those  of  us  who 
stood  near  him  loved  him.  He  was  one  of  the  most  likable 
men  you  will  ever  meet  —  so  noble,  so  unselfish,  so  full 
hearted. 

How  can  we  adjust  ourselves  to  the  fact  of  his  death? 
How  can  we  fathom  the  mystery  of  his  untimely  removal? 


36  HENRY     BAIRD     FAVILL 

TRIBUTE    BY   DR.   ARTHUR   M.    CORWIN 

MEDICINE,  politics,  education,  civics,  culture,  philan- 
thropy—  all  of  these  have  lost  a  mighty  advocate 
in  the  untimely  death  of  Dr.  Henry  Baird  Favill. 

It  is  rarel}^  indeed  that  we  find  a  physician  well  posted 
in  the  history  of  his  profession  and  in  vital  touch  with  the 
proof  sheets  of  medical  science;  extremely  busy  as  a  prac- 
titioner, enjoying  the  confidence  and  patronage  of  a  large 
private  practice  and  much  in  demand  as  a  consultant;  an 
able  lecturer  to  medical  students;  a  leading  spirit  upon 
many  important  committees  working  for  the  national 
betterment  of  the  profession  and  the  public;  a  dominant 
force  in  economic,  political,  and  philanthropic  movements; 
occupying  numerous  positions  of  trust ;  a  writer  and  speaker 
of  force,  widely  interested  in  human  affairs.  Such  a  man 
was  Dr.  Favill. 

He  was  a  splendid  fellow  in  every  way.  If  foes  he  had, 
they  must  have  been  hostile  to  his  high  ideals  or  jealous 
of  his  leadership  rather  than  hostile  to  him.  Personally,  he 
attracted  men  by  his  virile  traits,  his  wise  diplomacy,  his 
fine  sense  of  humor,  his  kindly  attitude  toward  humanity, 
his  ardent  friendship  for  all  outdoors,  and  his  keen  interest 
in  living  things. 

Blest  with  a  rugged  constitution  which  defied  strain 
and  stress,  he  was  a  man  of  commanding  presence.  When 
he  rose  to  speak  in  any  assembly,  his  tall,  magnificent 
physique,  athletic  bearing,  handsome  face  and  features  full 
of  character  aroused  anticipation  of  what  he  had  to  say 
which  was  never  disappointed.  In  later  years,  by  much 
practice,  he  had  mastered  a  clear,  trenchant  style  of  expres- 
sion which  went  to  the  heart  of  things.  Coupled  with  a 
natural  power  of  eloquence,  exceptional  command  of  lan- 
guage and  a  voice  full,  resonant,  and  musical.  Dr.  Favill 
had  a  certain  grace  and  force  about  him  that  carried  con- 
viction and  spoke  for  leadership. 


TRIBUTES      AND      RESOLUTIONS  37 

He  was  proud  of  the  Indian  blood  that  flowed  warm 
and  red  in  his  arteries;  and  I  doubt  not  that  the  charm  which 
nature  and  outdoor  life  had  for  him  and  his  love  of  animal 
life  were  part  and  parcel  of  this  heritage. 

In  going  he  has  left  a  void  which  it  will  be  difficult  to 
fill  by  any  one  individual.  He  has  left  a  wide  circle  of  real 
friends  and  ardent  admirers  in  all  walks  of  life.  He  has 
left  a  permanent  impress  of  his  life  and  character  upon  our 
times.     Nor  shall  his  noble  influence  cease  with  his  going. 

No  one  may  do  his  best  by  slavishly  imitating  another; 
he  can  only  be  himself  at  best.  But  great  men  and  women 
are  invaluable  sources  of  suggestion  in  developing  the 
finest  and  strongest  gifts  we  have.  Dr.  Favill  sought  to 
develop  himself  in  service  of  others.  He  lived  his  own  life 
in  his  own  way.  His  personality  was  all  his  own.  To 
emulate  this  attitude  shall  be  worth  while. 

Go  forth  to  be  thyself,  oh,  Man! 
Seek  not  to  ape  another's  plan; 
For  imitation  crude  but  meets 
The  needs  of  noisy  parakeets 
And  monkey-folk,  a  thumbless  nation, 
With  thumbless  grip  upon  creation. 
Go  be  thine  only  self,  with  will, 
And  thus  thy  destiny  fulfill. 


TRIBUTE  BY  DR.  PHILIP  KING  BROWN 

TO  few  men  has  been  given  the  ability  for  public  and 
personal  service  that  marked  Henry  Favill's  career. 
The  first  was  shown  by  his  unerring  instinct  for  reach- 
ing to  the  bottom  of  what  was  wrong  and  it  made  him  all 
his  life  an  advocate  of  preventive  medicine.  The  trail  he 
consistently  blazed  in  this  field  from  the  start  has  become 
the  highwa}/-  along  which  medicine  of  our  day  must 
advance.  But  the  other  gift  for  personal  service  was  not 
less  a  characteristic.     The  ability   for  catching   instantly 


2,S  HENRY      BAIRD     FAVILL 

the  other  person's  point  of  view  and  simply  and  directly 
giving-  sympathy  and  help  was  not  all.  He  knew  how  to 
develop  cliaracter  out  of  tragedy  and  weakness,  how  to 
inspire  and  to  encourage,  how  to  criticise,  how  to  lead  or 
to  command.  The  latent  forces  in  men  he  developed  and 
directed.  He  was  the  family  doctor  of  those  in  trouble  and 
here  again  his  one  aim  was  to  so  direct  that  he  taught  pre- 
vention, and  he  left  each  situation  securer  for  his  guidance. 

TRIBUTE  BY  R.  B.  OGILVIE 

OUR  lamented  friend,  Dr.  Henry  Baird  Favill,  was  in 
mind  and  heart  one  of  those  rarely  gifted  characters 
who  gave  to  scholarship  a  broader  culture,  to  phil- 
osophy a  bolder  range,  to  friendship  a  firmer  faith.  He  did 
many  things  well  but  nothing  so  well  as  he  talked.  His 
conversation  I  have  seldom  heard  equalled.  Though 
remarkably  fluent  and  select  it  was  neither  fluency  nor 
choice  of  diction,  nor  wit,  nor  sentiment  that  gave  it  its 
peculiar  power,  but  accuracy  of  statement,  keen  discrimi- 
nation, and  a  certain  weight  of  judgment  that  made  him 
the  idol  of  any  company.  He  was  everywhere  a  welcome 
guest.  His  arrival  was  a  holiday,  and  so  was  his  abode  with 
any  of  his  wide  circle  of  admiring  friends.  He  seemed  like 
a  king  of  some  parliament  of  love,  who  carried  the  key  to 
all  confidences,  and  to  whom  every  question  was  finally 
referred,  and  yet  there  was  so  much  of  intellectual  aim  and 
activity  breathed  through  his  alliance  as  to  give  dignity  to 
them  all.  He  was  indeed  the  friend.  This  was  his  voca- 
tion. Into  whatever  home  he  entered  he  brought  a  bene- 
diction of  truth,  justice,  tolerance,  and  honor.  He  knew 
by  intuition  and  experience  how  to  interpret  the  inner  life 
of  every  man  or  woman,  and  through  his  interpretation  he 
could  sooth  and  strengthen.  Such  was  the  man,  the  friend, 
the  citizen  we  fondly  loved  in  life,  and  whose  untimely 
death  we  so  much  deplore. 


T  R  I  n  IT  T  E  S      AND      RESOLUTIONS  39 

TRIBUTE  BY  F.  E.  BOLLING 

THE  JapaiK'se  have  a  saying  that  it  is  better  to  be  a 
crystal  and  he  broken  than  to  remain  Hke  a  tile  upon 
a  housetop.  Here  and  there  in  the  world  we  come 
upon  lives  that  have  somewhat  of  the  crystalline  in  them 
—  letting  through  their  transparence  some  rays  of  light 
into  our  dimmer  comprehensions,  making  less  blurred  our 
muddied  vision.  When  those  lives  end  it  is  our  dreary 
human  way  to  say  and  to  feel  that  the  crystal  is  broken. 

All  those  who  knew  Dr.  Favill  cry  out  .at  his  untimely 
death,  as  at  the  breaking  of  the  crystal,  the  crystal  through 
which  alone,  to  so  many,  the  light  of  life  was  clearly  visible. 

Dr.  Favill  walked  among  men  with  power  and  gentle- 
ness, a  king  in  the  first  democratic  sense  of  the  word,  a 
leader  among  his  kin,  the  father  of  his  folk,  and  his  folkship 
was  of  the  world.  His  leadership  was  founded  upon  his 
capacity  for  being  more  truly,  more  roundly  a  man  than 
the  men  among  whom  he  lived. 

His  kingship  was  maintained,  in  his  towering  superi- 
ority and  his  all  inclusive  equality.  In  him,  humanity  was 
intensified  into  a  many  gifted  perfection  of  service.  He 
was  a  physician,  a  leader,  ever  wise  in  instinct  and  learning. 
He  was  a  teacher,  a  seer,  untiring  in  tolerance  and  faith. 
He  was  a  citizen  endlessly  patient,  pouring  enormous  re- 
sources of  vision  and  hope  and  aid  into  the  abysses  of  sor- 
row. But  physician,  teacher,  citizen,  his  manifold  capac- 
ities were  indivisibly  blended  in  his  humanity.  First  and 
foremost  he  was  a  man  among  men. 

In  the  glare  and  confusion  of  a  confused  world,  in  the 
accumulation  of  duties  which  he  heaped  upon  himself,  his 
eyes  were  always  clear.  He  instantaneously  sorted  the 
true  frcm  the  false;  his  mind  unaware  of  processes,  grasped 
facts  and  duly  ordered  them,  as  swiftly  as  life  set  them 
before  him. 

He  loved  right  and  hated  wrong,  not  with  effort,  not 


40  HENRY     BAIRD     FA  V  ILL 

puritanically,  not  conventionally,  but  with  glad  freedom. 
He  was  right,  just  as  his  splendid  body  was  straight  and 
swift  and  free.  His  was  the  ecstatic  freedom  of  control. 
He  knew  neither  lassitude  nor  fraility. 

The  past  he  carried  with  him  in  his  heart  for  its  treasure 
of  experience  and  happiness.  But  unfruitful  regret,  fear 
of  yesterday,  to-day  or  to-morrow,  all  impotence,  none  of 
these  ever  dimmed  his  radiant  courage  or  hindered  for  even 
a  moment  his  royal  strength,  gentleness,  patience,  infinite 
pity;  of  these  his  vision  was  compounded.  He  read  his  own 
soul  without  error,  and  reflected  in  that  soul  were  the 
myriads  of  those  who  sought  solace  of  his  strength.  Unfal- 
tering he  read  their  manifold  meanings,  fusing  in  the  con- 
centrated fire  of  his  love,  a  multitude  of  warring  elements. 
For  himself  and  for  every  life  he  touched  he  moulded  achieve- 
ment out  of  pain  and  wisdom  out  of  despair. 

Now  that  he  is  gone  away,  ahead  of  those  whom  he 
always  led,  out  into  the  reaches  that  men  call  death,  life 
has  become  less  actual,  for  the  many  who  were  his  people. 
But  so  intense  a  personality  cannot  be  dimmed.  Death 
containing  him  becomes  less  secret.  Of  the  many  meanings 
embodied  in  such  a  life,  surely  the  greatest  must  be  that  a 
crystal  cannot  be  shattered;  that  in  a  world  of  fearsome 
phantoms  nothing,  not  even  the  last  terror  of  death,  can 
diminish  the  reality  of  such  courageous  and  true  manhood. 

TRIBUTE   BY   E.    L.    FOLEY 

"It  is  easy  in  the  world  to  live  after  the  world's  opinion;  it 
is  easy  in  solitude  to  live  after  our  own;  but  the  great  man  is  he 
who  in  the  midst  of  the  crowd  keeps  with  perfect  sweetness  the 
independence  of  solitude." 

EMERSON    has    described    Dr.    Favill    more   fittingly 
than  the  writer  of  this  brief  sketch  possibly  can.     A 
graduate  of  the  University  of  Wisconsin  and  of  Rush 
Medical  College,  Dr.  Favill  began  his  medical  practice  in 


T  \<  r  B  IT  T  P:  S      AN  I)      R  10  S  O  L  IJ  'I   I  D  N  S  41 

Chicago  in  1894.  For  more  than  twenty  ye^irs  he  was,  in 
every  sense  of  the  term,  a  learlin^  eitizen.  Sane,  vigorous, 
essentially  just,  fundamentally  scientific  in  his  searching 
analysis  of  conditions,  whether  pathological,  civic,  or  per- 
sonal, he  was  a  tower  of  strength  to  all  those  fortunate 
enough  to  know  him  or  to  work  with  him. 

A  senior  pupil  nurse  at  St.  Luke's  Hospital,  who  had 
just  finished  his  course  of  lectures,  once  said  of  Dr.  Favill : 
"It  is  not  always  what  he  says,  but  what  he  makes  you  think 
out  for  yourself  that  makes  Dr.  Favill's  class  so  interesting." 
This  was  true  of  Dr.  Favill  to  a  remarkable  degree.  All 
men  and  women  —  civic  workers,  professional  workers,  and 
others  who  consulted  him,  carried  their  problems  and  per- 
plexities to  him,  not  because  he  had  a  panacea  for  every 
ill,  but  because  his  genuine  interest,  his  keen  searching 
questions,  and  his  ability  to  make  even  vague  thinkers 
crystallize  their  own  thoughts,  suddenly  clarified  the  diffi- 
culty of  the  person  seeking  advice  and  enabled  her  to  put 
her  own  mental  house  in  order.  Dr.  Favill  was  never  too 
busy  to  give  this  sort  of  help.  He  seldom  spoke  dogma- 
tically; he  frequently  advised  patience;  but  he  never  sent 
one  away  dissatisfied  or  ill  at  ease. 

The  various  offices  which  he  held  at  one  time  or  another 
—  president  of  the  Chicago  Municipal  Voters'  League, 
of  the  City  Club,  of  the  Chicago  Tuberculosis  Institute, 
of  the  Chicago  Medical  Society,  a  council  chairman  of  the 
American  Medical  Association,  director  of  the  American 
Association  for  Labor  Legislation,  etc. — testify  to  the  esteem 
in  which  he  was  held  as  a  physician  and  a  citizen.  The 
genuine  and  w^idespread  grief  felt  at  his  death  show^ed  that 
his  friends  thought  first  of  Dr.  Favill  and  his  friendship, 
and  of  these  other  honors  later. 

As  nurses  we  owe  very  much  to  Dr.  Favill.  For  years 
he  gave  his  best  to  many  of  us.  As  president  of  the  Staff 
of  St.  Luke's  Hospital  and  in  his  connection  with  other 
hospitals  in  the  city,  he  was  always  interested  in  nursing 


42  HENRY     BAIRD     FA  V  ILL 

problems;  his  constant,  unswerving  support  of  high  stand- 
ards of  the  service  which  he  felt  we  not  only  owed  but 
desired  to'  give  every  patient  who  came  to  us,  was  a  con- 
stant inspiration  and  stimulation  to  every  nurse  who  worked 
for  him. 

Two  addresses,  one  given  at  our  National  Meeting  in 
San  Francisco  and  published  in  the  January  Journal  oj 
Nursing,  the  other  published  in  the  Pennsylvania  Medical 
Journal  (November,  191 5),  entitled  "The  Public  and  the 
Medical  Profession  —  A  Square  Deal,"  will  enable  us  all  to 
realize  the  influence  such  a  friend  must  have  had  on  the 
members  of  the  medical  and  nursing  profession  alike.  To 
continue  the  work  believing  that  we  still  have  his  support 
and  encouragement  and  interest  is  the  finest  tribute  which 
we,  as  nurses,  can  pay  the  memory  of  Dr.  Favill. 


TRIBUTE   BY   J.  C.  WILLIAMS 

IT  is  still  dififiicult  to  speak  of  this  man  as  one  who  has 
been  but  no  longer  is,  so  definite  was  the  impression 
left  by  his  unique  personality.  It  is  equally  difficult 
to  give  an  understanding  of  his  character  —  for  more  than 
any  other  of  his  time  he  was  all  things  to  all  people  and, 
except  in  the  sense  of  being  of  universal  service,  his  relation 
to  each  was  quite  different  in  internal  as  well  as  external 
aspect.  His  response  was  always  entirely  genuine  for  he 
had  an  unlimited  human  sympathy.  He  realized  as  no  one 
else  could  our  restrictions  and  limitations,  and  accepted 
them  quite  simply,  in  an  entirely  uncritical  attitude.  That 
was  his  keynote, —  the  uncritical  attitude, — for  criticism 
is  seldom  friendly, — it  is  destructive,  not  creative.  His 
gift  was  constructive  and  led  him  toward  building  up  —  not 
tearing  down. 

He  had,  in  the  broadest  sense,  a  fine  scientific  and 
analytical  mind,  but  the  element  in  his  professional  suc- 
cess, exceeding  his  medical  skill,  was  his  understanding  of 


TRinUT]<:S      AND      R  ICSOL  UT  I  ONS  43 

people.  Ill  lliis  particular  line  I  Ix^licve  he  was  never  sur- 
passed—  if  indeed  ever  equalled.  The  impersonal  attitude 
of  the  seientist  was  impossible  to  him.  Symptoms  and 
medical  details  of  an  average  case,  based  on  painful  trifles, 
bored  him  icTril)ly.  The  (nitward  expression  of  inward 
discontent  or  depression  among  well-fed  and  well-housed 
people  was  extremely  irksome.  But  the  situation  itself, 
if  not  the  individual,  and  each  person's  reaction  to  his  or 
her  particular  problem,  was  always  of  interest. 

His  greatest  endowment  was  the  gift  of  analysis  and  it 
enabled  him  to  approach  the  most  delicate  problem  without 
creating  an  atmosphere  of  strain  or  intrusion.  I  have 
often  heard  him  say,  "I  am  not  quite  sure  of  the  psychology 
of  this  situation,"  but  the  struggle  was  half  won  by  recog- 
nizing that  a  psychologic  as  well  as  physiologic  aspect 
did  exist.  Much  as  it  is  needed,  I  have  not  found  such 
insight  usual  in  his  profession.  And  the  fact  that  this 
analytical  instinct  was  entirely  uncritical  is  far  more  signif- 
icant of  the  man.  His  judgments  were  based  on  the  spirit 
rather  than  the  act.  Action,  he  felt,  was  often  involuntary 
and  impulsive  through  the  pressure  of  unsympathetic  envi- 
ronment, and  by  looking  more  deeply  into  the  human  heart 
he  accepted  results  and  tolerated  issues  from  the  viewpoint 
of  spiritual  effort. 

For  women,  especially,  whether  weak  ph3'Sically,  men- 
tally, or  morally,  he  had  the  vastest  sympath}^  and  it  is 
difficult  to  realize  that  any  man  could  so  thoroughly  under- 
stand women.  He  was  born  —  not  made  —  a  physician, 
and  in  real  suffering,  whether  physical  or  mental,  his  touch 
was  the  gentlest,  and  his  diagnosis  keen,  shrewd,  and 
accurate. 

He  had  his  moments  of  intense  introspection  and  at 
such  times  felt  himself  a  failure  because  life  had  not  given 
the  things  he  thought  he  valued  most.  He  was  always  a 
driven,  restless,  overburdened  creature,  and  it  is  doubtful 
if  the  things  he  thought  could  mean  so  much  would  ever 


44  HENRY     BAIRD     FA  V  ILL 

have  contented  or  held  him.  He  often  said  that,  while  the 
world  spoke  of  him  as  a  success,  only  he  himself  knew  how 
he  had  failed.  He  was  the  loneliest  creature  living.  I 
have  heard  that  "He  is  strongest  who  stands  most  alone," 
so  perhaps  this  was  one  of  the  great  elements  of  his  strength. 

He  literally  could  forgive  all  things.  Average  standards 
of  right  and  wrong,  morality  or  immorality,  interested 
him  very  little  except  as  a  public  commodity.  He  had  a 
strong  civic  conscience  —  a  keen  sense  of  community  good 
or  evil.  But  in  the  personal  case  it  was  his  feeling  that 
average  judgments  interfered  with  liberty  —  always  sacred 
to  him.  "Morality  or  immorality  is  chiefly  a  question  of 
giving  pain.  One  must  not  do  that  unnecessarily,"  he  said. 
He  was  entirely  fearless  and  followed  his  judgments  regard- 
less of  consequences.  He  thought,  indeed,  that  he  was 
indifferent  to  consequences.  In  this  I  never  agreed.  I 
always  felt  he  was  extremely  sensitive  to  criticism  and 
inwardly  hurt  by  much  that  was  unfair  and  unjust.  His 
standards  were  not  the  standards  of  other  people  —  his 
code  was  his  own,  and  by  some  he  might  even  have  been 
called  lawless.  He  was  right  thinking  and  right  minded, 
although  entirely  unconventional  as  to  accepted  forms. 
Everything  vital,  natural,  or  elemental  was  sacred  to  him, 
regardless  of  its  social  or  legal  aspect,  and  he  allowed  others 
as  great  liberty  of  thought  or  action  as  he  himself  demanded. 
Indeed,  if  he  worshipped  any  god,  it  was  personal  liberty. 
But  though  he  never  forced  his  beliefs  on  others,  detesting 
any  such  control,  still  without  wish  or  effort  he  probably 
dominated  more  lives  than  any  individual  of  his  time. 
With  blind  faith  his  lead  was  followed,  and,  because  that 
lead  was  sane  and  wise,  harm  never  came  of  it.  "Life  is 
not  a  question  of  achievement  but  of  vision,"  he  wrote  to 
me  long  ago. 

Intellectually  he  was  the  strongest  man  I  have  ever 
known,  and  his  memory  was  as  amazing  as  his  mind.  He 
told  me  once  that  as  he  seldom  found  time  to  re-read  the 


TRIMUTICS      AND      R  I :  S  O  L  U  T  I  O  N  S  45 

things  he  liked,  ho  memorized  Ihem  at  once,  and  so  his 
storehouse  of  precious  words  was  (dways  with  him.  He 
could  literally  recite  volumes.  Plis  taste  in  literature  and 
music  was  unique.  Style  counted  for  nothing  — only  things 
that  touched  human  chords  had  any  meaning.  He  was 
easily  stirred  emotionally,  often  extremely  irritable,  and 
he  had  a  quick  dramatic  instinct.  However,  his  sense  of 
the  humorous  was  so  dominant  that  he  could  relapse  into 
it  at  once  from  the  tensest  moment.  His  wit,  indeed,  was 
of  a  subtle,  brilliant,  and  very  rare  type. 

He  accepted  everyone's  cares  and  burdens  so  cheerfully 
that  almost  no  one  reaHzed  his  consuming  fatigue  the 
last  years  of  his  life.  He  had  formed  a  habit  of  consid- 
ering every  moment  not  overcrowded  with  activities,  as 
time  wasted. 

If  you  can  force  your  heart  and  nerve  and  sinew 
To  serve  your  turn  long  after  they  are  gone, 

And  so  hold  on  when  there  is  nothing  in  you 

Except  the  Will  which  says  to  them:     "Hold  on." 

He  realty  did  this  thing,  but  his  magnificent  physique 
gave  no  outward  sign.  There  must  have  been  years  in  the 
past  when  life  for  him  was  a  splendid  adventure,  but  that 
time  had  gone  forever.  One  cannot  believe  he  went  willingly 
when  death  came,  but  at  least  he  was  always  ready,  though 
not  in  the  dogmatic  sense.  If  he  felt  it  near  there  must 
have  been  a  grim  sort  of  tragedy  in  those  last  hours  —  a 
quizzical  questioning  attitude  that  was  neither  horror  nor 
fear,  but  rather  a  solemn  acceptance  of  Fate's  final  fling  at 
him.  He  could  have  had  no  regrets,  for  w'hat  he  had  done, 
he  had  done,  accepted  the  price  cheerfuUy,  and  put  it  all 
out  of  his  mind  forever.  But  he  died  as  he  had  lived  — 
unbroken  and  untamed. 

Out  of  the  night  that  covers  me 
Black  as  the  pit  from  Pole  to  Pole, 


46  HENRY      BAIRD      FAVILL 

I  thank  whatever  gods  may  be 
For  my  unconquerable  soul. 

In  the  fell  clutch  of  circumstance 

I  have  not  winced  nor  cried  aloud; 
Under  the  bludgeonings  of  chance 

My  head  is  bloody,  but  unbowed. 

Beyond  this  place  of  wrath  and  tears 

Looms  but  the  horror  of  the  shade 
And  yet  the  menace  of  the  years 

Finds,  and  shall  find  me,  unafraid. 

It  matters  not  how  straight  the  gate, 

How  charged  with  punishments  the  scroll, 

I  am  the  Master  of  my  Fate, 
I  am  the  Captain  of  my  soul. 

His  simplicity  was  almost  aggressive,  and  I  never  could 
think  of  him  in  rhetoric  —  "That  noble  man,  this  imperial 
figure," — but  rather  as  this  intensely  human  brother  who 
had  stood  among  us,  leaving  the  memory  of  faults  as 
generous  and  as  lovable  as  his  virtues;  this  big,  strong 
man  who  accepted  life  so  passionately  in  every  form  pre- 
sented, without  revenge,  remorse,  or  repinings,  and  who 
feared  it  neither  at  its  best  nor  at  its  worst. 

In  a  recent  letter  I  find,  "Don't  be  discouraged.  Life 
is  all  ahead  of  you  and  large  in  possibilities.  The  future 
one  cannot  see  in  outline  —  but  in  principle  one  can  —  and 
I  could  not  be  so  complacent  in  seeing  my  boy  marching 
into  a  life  of  hilliest  possibilities,  if  I  did  not  know  that 
there  is  a  bigness  that  can  overshadow  and  overcome  them. 
Later, — "I  am  glad  of  a  respite  —  to  be  out  of  the  turmoil 
for  a  few  breaths."  But  it  was  only  a  few  breaths  he 
wanted  —  not  eternity.  Still  eternity  is  his,  and  deep  in 
that  now  quiet  heart  rests  this  last  great  secret.  In  fifty- 
five  hurried,  harrassed  years  his  threescore  years  and  ten 


TRIBUTI<:S      A  N  [)      FMC  S  O  LU  T  I  O  N  S  47 

were  fully  lived, — "for  livin^^"  he  always  said,  "means 
serving." 

One  does  not  see  him  led  by  the  ehureh  before  the 
tribunal  of  a  forgiving  Diety  — but  rather  re-aVjsorbed  by 
great  Nature  herself.  This  was  his  first  lov(:  and  his  last. 
Few  have  ever  felt  the  earth  and  its  forees  as  he  felt  them. 
I  think  of  him  always  surrounded  by  the  elements  -  facing 
with  savage  joy  the  wildest  winds,  or  resting  in  the  peace 
of  quiet,  star-lit  woods.  These  things  I  quote  in  full 
measure  because  he  loved  them  vSo: 

Do  you  fear  the  force  of  the  wind, 

The  slash  of  the  rain? 
Go  face  it,  and  fight  it; 

Be  savage  again. 
Go  hungry  and  cold  like  the  wolf; 

Go  wade  like  the  crane. 
The  palm  of  your  hand  will  thicken ; 

The  skin  of  your  cheek  will  tan. 
You'll  grow  ragged  and  weary  and  swarthy, 

But  you'll  walk  like  a  man. 

Waken Drink  of  thy  first  mother's  life,  a  balsam  for 

every  ill,  mother's  milk  that  shall  unpoison  thy  blood,  and  bring 
the  thick,  black  drops  to  naught.  Child  of  the  weather  and  all 
outdoors,  latest  child  of  mine,  draw  from  me  will,  and  might,  and 
the  love  of  the  undefiled,  acquaintance  with  the  rune  that  shall 
destroy  the  venom  that  taints  you,  shall  blast  the  wrong  done 
you !  Draw  large,  free  draughts !  Return  to  me,  thou  man-child  I 
I  give  thee  the  strength  of  my  forests,  my  rivers,  my  sea,  my  sun- 
shine, my  starshine,  my  own  right  arm,  my  heart!  I  cleanse 
thee.  The  slime  of  the  long  years  shall  not  cling  to  thee.  I 
start  thee  afresh,  new-bom.  By  night  in  my  star-hiing  tent  the 
gods  shall  visit  thee,  by  day  thou  shalt  walk  in  the  way  of  becom- 
ing a  god  thyself.  I  give  thee  scom  for  the  ignoble,  trust  in  thy 
fellow,  dependence  on  thine  OA^m  lusty  sinew  and  unconquerable 
will,  —  familiar  friend  of  hardship  and  content,  spare  and  pure 
and  strong,  —  joy  in  the  earth,  the  sun,  the  wind,  faith  in  the 


48  HENRY      BAIRD     FAVILL 

unseen.  This  is  thy  birthright.  Whatever  else  the  years  may 
bring,  see  that  thou  do  it  no  wrong.  I,  the  unpolluted,  strong 
wild  strain  in  th}^  blood,  the  vital  savage,  save  thee  from  thyself. 
Sleep,  now,  sweet  hope.  The  winds  sing  to  thee,  the  waves  lull 
thee,  the  stars  affright  thee  not!     Dear  son  of  thy  mother,  sleep! 

There  were  many  burdened  hearts  to  cry,  "They  have 
taken  my  Lord  from  m.e  and  I  know  not  where  they  have 
laid  him," — but  Nature  could  answer  each,  "I  have  but 
taken  my  own.  From  my  breast  I  have  lifted  him  and  in 
my  heart  I  have  laid  him."  Humbly  and  reverently  let  us 
petition  whatever  gods  there  be  that  peace  such  as  this 
is  his,  at  last. 

As  monumental  bronze,  unchanged  his  look; 
A  soul  that  pity  touched,  but  never  shook; 
Trained  from  his  tree-rocked  cradle  to  his  bier, 
The  fierce  extremes  of  good  and  ill  to  brook 
Impassive  —  fearing  but  the  shame  of  fear  — 
A  stoic  of  the  woods  —  a  man  without  a  tear. 

{A  Few  Months  Later) 

In  looking  now  at  the  tragic  incompleteness  of  his  life, 
it  assumes  a  different  aspect.  My  memories  at  first  seemed 
made  of  pain  —  a  throbbing,  consuming,  living  pain  for  him 
—  for  all  the  things  he  had  not  had,  and  had  not  been. 
Unconsciously  I  had  pictured  for  him,  toward  the  end  of 
time,  a  story-book  sort  of  peace  and  poise;  a  complacent 
composure.  Such  a  hope  was  futile  and  quite  unintelligent. 
Now,  at  last,  I  see  it  all  differently.  The  pain  is  there, 
deeper,  but  it  is  a  personal  thing  and  applies  to  those  of  us 
who  feel  unable  still  to  meet  the  days  without  him.  I  know 
now  that  there  could  have  been  no  rest  for  him,  ever.  At 
last  I  can  see  that  because  of  the  influence  left  by  his  life, 
it  matters  very  little  what  his  personal  reaction  to  the  cir- 
cumstances in  that  life  happened  to  be.  A  great  man  has 
stood  among  us  —  touched  us  —  definitely  influenced  us  — 


TRII5lJTi<:S      AND      R  I-:  S  C)  f.  [I  T  I  f)  N  S  49 

left  his  mark  x]]H>n  us.  'I'cmpestuous  and  tormented, 
vulnerable  and  faulty,  hiil  Ix-yonfl  .'ill,  human,  he  too 
might  have  said  out  of  the  agony  of  untold  struggles: 
(I  quote)  "It  is  a  struggle  worthy  of  fine  souls  to  tell  the 
truth — but  it  is  a  far  greater  struggle  to  know  what  the 
truth  is.  It  is  that  struggle,  being  the  only  jjrecious  thing 
I  have,  that  I  bequeath  to  you.  There  is  nothing  more  I 
can  say,  save  to  wish  you  wel  1 . "  ^fhe  thing  we  call  happiness 
is  for  very  few.  It  comes  to  none  who  think  deeply  in  any 
positive  form.  It  was  not  meant  for  him  at  all.  Only  a 
broken  spirit  can  compromise  with  essentials  and  he  faced 
both  his  own  problems  and  those  of  other  people  unflinch- 
ingly. All  could  feel  his  bigness  while  few  understood  it, 
because  he  deliberately  cast  about  himself  an  illusion  that 
was  not  easy  to  penetrate.  He  was  armed  with  a  subtle 
sort  of  bluff.  There  was  no  insincerity  in  this.  Through 
deep-rooted  characteristics  that  may  have  been  racial  it 
was  actually  necessary,  in  him,  to  self-preservation.  It 
developed  chiefly,  I  think,  through  his  dread  of  the  pene- 
trating sort  of  curiosity  that  he  feared  might  sometime 
uncover  in  him  such  weaknesses  as  were  constantly  being 
uncovered,  for  his  scrutiny,  by  others.  With  the  rarest 
delicacy,  he  could  meet  and  treat,  even  to  the  healing  point, 
many  of  these  mental  sores.  It  revolted  him,  however,  to 
think  that  in  even  the  gentlest  way  others  might  intrude 
upon  the  precious  privacy  of  his  reserve.  This  wall  of  stern 
control  became  so  habitually  his  refuge  that  it  w^as  in  the 
end  a  definite  self-deception.  But  beneath  and  beyond  it 
his  life  will  stand  forever  as  a  passionate  protest  against 
every  form  of  sham.  As  for  his  death  —  well  —  a  great 
scientist  wrote  over  the  grave  of  one  who  had  blazed  that 
path  ahead,  even  as  in  life  he  had  blazed  all  others,  "We 
have  loved  the  stars  too  well  to  fear  the  night." 


FORMAL   RESOLUTIONS 


RESOLUTIONS  OF  THE  CITY  CLUB   OF  CHICAGO 
February  21,   191 6 

WHEREAS,    Death  has  taken   Henry  Baird   Favill, 
who  was  a  charter  member  of  this  Club,  was  con- 
tinuously a  member  of  its  Board  of  Directors  from 
1906  until  his  death  on  February   20,    191 6,    and  was  its 
President  during  the  years  1 9 1  o  - 1 1   and  1 9 1 1  - 1 2 ;  and 

Whereas,  As  a  physician  he  was  not  only  skillful  in  the 
treatment  of  disease,  but  studied  and  emphasized  means  of 
prevention  of  disease  and  assiduously  worked  for  the  adop- 
tion of  safeguards  to  the  public  —  such  as  proper  sanitation, 
the  inspection  of  milk  and  foods,  and  the  wise  regulation 
of  the  practice  of  medicine,  so  that  not  only  the  health  of 
individuals,  but  pre-eminently,  the  health  of  the  com- 
munity was  the  constant  object  of  his  efforts;    and 

Whereas,  As  a  citizen  he  unsparingly  gave  his  thoughts 
and  energy  to  movements  for  the  improvement  of  civic 
and  social  conditions,  bringing  into  play  with  great  effec- 
tiveness the  same  incisive  analysis  of  conditions,  the  same 
ability  to  pierce  beneath  surface  symptoms  to  underlying 
causes  that  marked  his  diagnosis  as  a  physician,  so  that 
his  life  was  an  inspiring  example  of  high  public  service;  and 

Whereas,  He  has  always  been  a  loyal  member  of  this 
Club  and  his  wise  direction  as  President  amid  the  many 
difficult  questions  of  policy  which  arose  during  the  period 
when  the  Club  moved  into  its  present  building  was  of 
inestimable  value,  and  since  that  time  his  thoughtful 
counsel  as  director  has  been  most  helpful;    and 

so 


TRIBUTES      AND      K  K  S  O  I.  U  T  I  T)  N  S  51 

Whereas,  Beyond  all  that  he;  has  accomplished,  great 
as  it  was,  his  personality  as  a  man  — frank,  companionable, 
kindly, — won  for  him  affection  of  all  the  members  of  the 
Club  and  led  them  to  prize  his  hopefulness  of  view,  his 
sympathy  and  his  largeness  of  heart  and  his  innate  democ- 
racy;   now,  therefore,  be  it 

Resolved,  By  the  Directors  of  the  City  Club  of  Chicago, 
that  in  behalf  of  its  members  they  record  their  deep  sense 
of  loss  in  the  death  of  Dr.  Favill  and  that  they  express 
their  heartfelt  sympathy  for  his  family;  and  be  it  further 

Resolved,  That  a  copy  of  these  resolutions  be  sent  to 
his  wife  and  son. 


RESOLUTIONS   OF   THE   UNIVERSITY   OF 
WISCONSIN   CLUB    OF   CHICAGO 

Resolved,  That  the  University  of  Wisconsin  Club  of 
Chicago  has  heard  with  profound  sorrow  of  the  death  of 
Henry  B.  Favill,  one  of  its  most  distinguished  members. 

He  was  respected  by  all  who  knew  him,  for  his  lofty 
ideals,  his  elevation  of  soul,  and  for  his  great  learning, 
which  by  much  reflection  had  ripened  into  wisdom.  He 
was  a  constant  inspiration  to  the  young  and  an  example 
to  them  of  what  a  good  citizen  should  be.  Professionally 
busy,  he  was  never  too  busy  to  lend  a  helping  hand  to  an}' 
enterprise  which  promised  uplift  to  his  fellows  or  to  the 
community  of  which  he  was  a  part.  Our  loss  is  great  but 
that  of  his  immediate  family  is  much  greater. 

Resolved,  Further,  That  we  extend  our  profound  sym- 
pathy to  the  members  of  his  family,  and  that  a  copy  of 
these  resolutions  be  sent  to  them. 

A.  E.  Van  Hagan, 

President. 


HENRY     BAIRD     FA  V  ILL 


RESOLUTIONS   OF   THE   MEDICAL   BOARD   OF 
ST.    LUKE'S   HOSPITAL 

March  21,   1916 

Whereas,  The  members  of  the  Medical  Board  of  St. 
Luke's  Hospital  realize  an  irreparable  loss  in  the  untimely 
death  of  their  beloved  President,  Henry  Baird  Favill;    and 

Whereas,  They  are  overwhelmed  with  sorrow; 

Resolved,  That  they  individually  and  as  a  body  put  on 
record  their  appreciation  of  one  who,  in  a  manner  unique 
in  his  time  and  age,  stood  for  rectitude,  courage,  simplicity 
and  noble  manhood,  and  who  gave  moral  tone  to  every 
community  in  which  he  lived; 

Resolved,  That  a  copy  of  these  resolutions,  with  their 
deep  sympathy,  be  sent  to  the  Family  of  their  dear  friend. 

{Committee)     Archibald  Church 

William  Allen  Pusey 
Frank  Cary 

RESOLUTIONS   OF   THE   BOARD   OF   TRUSTEES 
OF   ST.    LUKE'S   HOSPITAL 

June  4,   1916 

Whereas,  It  has  pleased  Almighty  God  to  take  unto 
Himself  our  friend  and  fellow-laborer,  Henry  Baird  Favill, 
at  a  time  when  in  our  expectation,  many  years  of  the  use- 
ful service  which  has  made  him  beloved  and  honored  in 
this  community  still  lay  before  him,  thereby  reminding  us 
that,  "There's  a  divinity  that  shapes  our  ends,  rough- 
hew  them  how  we  will"; 

Be  It  Resolved,  That  we,  the  Trustees  of  St.  Luke's 
Hospital,  place  on  record  our  appreciation  of  his  life,  char- 
acter and  death. 


'I'  R  I  B  n  T  I<:  S      AN  D      R  K  S  O  f.  (J  T  I  O  N  S  53 

Rich  in  knowk'dj^e  anr]  experience,  abounding  in  vi^or 
and  sympathy,  Dr.  P'avill,  though  called  away  in  the  full 
flower  of  life,  had  made  a  name  for  himself  which  will  be 
remembered  in  Chicago  for  many  years  to  come.  His 
activities  extended  far  beyond  his  profession,  in  which  he 
attained  an  eminence  reached  only  by  men  of  the  greatest 
skill,  wisdom  and  perseverance.  He  was  alert  to  all  that 
had  a  bearing  on  human  interests  and  public  welfare; 
indeed,  considering  his  laborious  and  absorbing  work  as  a 
physician,  it  is  surprising  that  he  should  have  accomplished 
so  much  in  social  and  civic  enterprises.  He  was  a  tower 
of  strength  for  all  who  appealed  to  him;  a  man  of  vision 
and  high  ideals,  broad-minded  and  patient,  gentle  and 
considerate,  and,  to  those  who  sought  him,  ever  a  wise 
counselor  and  faithful  friend.  The  world  is  the  better 
for  his  having  been  in  it.  We  recognize  his  generous  and 
efficient  service  in  St.  Luke's  Hospital;  and  in  behalf  of 
the  Hospital  we  acknowledge  its  loss  in  his  death,  and 
its  gratitude  for  his  great  usefulness  and  deep  interest  in 
all  its  activities. 


RESOLUTIONS   OF   THE   CHICAGO   SOCIETY   OF 
INTERNAL    MEDICINE 

Whereas,  On  February  20,  1916,  death  removed  Dr. 
Henry  B.  Favill  from  the  rolls  of  the  Society  of  Internal 
Medicine;  and 

Whereas,  Dr.  Favill  was  one  of  the  most  highly  esteemed 
members  of  this  Society,  a  wise  and  skillful  physician, 
beloved  as  a  man  and  admired  as  a  citizen;  therefore  be  it 

Resolved,  That  with  the  other  ph^'sicians  and  laymen 
of  Chicago,  we  mourn  the  loss  of  this  great  and  good  man, 
and  extend  to  the  bereaved  wiie  and  son  our  profound 
sympathy;  and  in  token  thereof  be  it  further 


54  HENRY      BAIRD      FA  V  ILL 

Resolved,  That  the  resolutions  be  spread  upon  the  records 
of  the  Society  of  Internal  Medicine,  and  a  copy  thereof  be 
conveyed  to  Dr.  Favill's  family. 

Hugh  T.  Patrick 

Charles  Spencer  Williamson 
Eugene  S.  Talbot,  Jr. 

RESOLUTIONS   OF   THE   CHICAGO 
NEUROLOGICAL   SOCIETY 

Whereas,  On  February  20,  1916,  Dr.  Henry  Baird-Favill 
departed  this  life;    and 

Whereas,  For  many  years  he  had  been  a  beloved  and 
admired  member  of  the  Chicago  Neurological  Society;  and 

Whereas,  Dr.  Favill  was  not  only  a  physician  of  great 
skill  and  unusual  scientific  attainments,  loyal  alike  to  his 
patients  and  his  ideals,  great  in  his  kindness  as  in  his  strength, 
but  also  a  man  of  marvelously  manifold  and  wonderfully 
effective  activities  in  the  broad  sphere  of  humanitarianism ; 
therefore,  be  it 

Resolved,  That  in  the  passing  away  of  Dr.  Favill  the 
Chicago  Neurological  Society,  the  medical  profession,  the 
City  of  Chicago,  and  the  people  of  the  United  States  have 
suffered  a  great  loss,  but  that  we  are  bigger  and  better  for 
his  having  lived  and  labored;    and  be  it 

Resolved,  That  we  extend  to  his  bereaved  family  our 
profound  sympathy,  that  these  resolutions  be  spread  upon 
our  records,  and  a  copy  thereof  sent  to  the  family  of  our 
late  associate,  and  to  the  Journal  of  Nervous  and  Mental 
Disease. 

(Committee)       Hugh  T.  Patrick,  Chairman 
Lewis  J.  Pollock 

SiGMUND    KrUMHOLZ 


T  R  F  lUJ  T  re  S      AND      R  I'".  S  O  I.  I J  T  I  O  N  S  55 


RESOLUTIONvS   OV   THE   SENIOR   CLASS   OF 
RUSH   MEDICAL  COLLEGE 

Whereas,  Almij^hty  God  in  liis  infinilc  goodness  and 
mercy  has  called  from  this  world  rjur  beloved  friend  and 
teacher;  and 

Whereas,  We  feel  deeply  the  loss  of  our  departed  teacher; 

Be  It  Resolved,  That  we,  the  members  of  the  Senior 
Class  of  Rush  Medical  College,  express  herein  our  deep 
grief;  and 

Be  It  Further  Resolved,  That,  as  members  of  the  Senior 
Class  of  Rush  Medical  College,  we  extend  to  his  family 
our  most  sincere  and  heartfelt  sympathy  in  their  recent 
sorrow;  and 

Be  It  Further  Resolved,  That  these  resolutions  be  recorded 
in  the  minutes  and  that  a  copy  be  sent  to  his  family. 

For  the  Class  of  'i6:         Francis  E.  Turgasen 

Ralph  W.  Carpenter 


RESOLUTIONS   OF   THE   NORTH   SIDE   BRANCH 
OF   THE   CHICAGO   MEDICAL   SOCIETY 

Whereas,  A  Great  Physician,  a  devoted  worker  for  prog- 
ress, a  splendid  example  of  noble,  unselfish,  productive 
idealism,  and  a  staunch  friend  of  our  profession,  has  been 
taken  from  us; 

Whereas,  He  stood  for  all  that  is  elevating  and  fine  in 
our  profession,  giving  in  a  large  measure  of  his  time  and 
his  remarkable  energy  and  thought  to  the  betterment  of  his 
professional  brethren  and  to  the  community  at  large;  and 

Whereas,  This  society  has  sustained  a  loss  in  the  death 


56  HENRY     BAIRD     FAVILL 

of  Henry  B.  Favill  impossible  to  replace;    now,  therefore, 
be  it  .^ 

Resolved,  That  the  Secretary  of  the  Association  be  in- 
structed to  spread  on  the  minutes  this  memorial  of  our 
inconsolable  grief  and  regret,  and  that  he  be  directed  to 
send  to  the  bereaved  family  a  copy  of  this  resolution  as  an 
expression  of  our  sympathy  and  of  our  love  for  a  man  who 
measured  so  large  in  the  world  in  everything  that  makes 
for  manhood  and  good  citizenship. 

{Committee)         Albert  J.  Ochsner 
F.  A.  Jefferson 


RESOLUTIONS   OF   THE 
NORTHWESTERN   UNIVERSITY  SETTLEMENT 

March  17,   1916 

Whereas,  Doctor  Henry  Baird  Favill,  a  member  of  the 
Advisory  Council  of  Northwestern  University  Settlement, 
has  been  suddenly  called  by  death;  and 

Whereas,  Northwestern  University  Settlement  felt  rich 
in  the  possession  of  his  sympathy  and  interest,  and  his 
membership  on  the  Advisory  Council;  therefore 

Be  It  Resolved,  That  the  members  of  the  Council  of 
Northwestern  University  Settlement  feel  that  the  Settle- 
ment shares  with  every  other  organization  with  which 
Doctor  Favill  was  connected,  a  deep  and  irreparable  loss; 
and 

Be  It  Further  Resolved,  That  a  copy  of  these  resolutions 
be  spread  upon  the  Minutes  of  this  Meeting  and  that  a  copy 
be  sent  to  Doctor  Favill's  family. 


TRIBUTF>S      AND      K  K  S  O  MJ  T  I  O  N  S  57 


RESOLUTlONvS   OF   Tllli   AMERICAN 
NURSES'   ASSOCIATION 

Whereas,  The  American  Nurses'  Association  feels  a 
sense  of  real  loss  in  the  death  of  Dr.  Henry  Baird  Favill 
of  Chicago; 

Be  It  Resolved,  That  this  Association  express  its  sincere 
appreciation  of  his  unfailing  sympathy  and  ready  assistance 
in  all  nursing  problems  and  his  personal  service  in  behalf 
of  many  women   of  our  profession. 

The  National  League  of  Nursing  Education  and  The 
National  Organization  for  Public  Health  Nursing  unite 
with  the  American  Nurses'  Association  in  this  resolution. 


RESOLUTIONS   OF  THE   NATIONAL   COMMITTEE 
FOR   MENTAL   HYGIENE 

Whereas,  Dr.  Henry  Baird  Favill,  who  died  in  Spring- 
field, Massachusetts,  February  20,  1916,  was  one  of  the 
founders  and  first  President  of  the  National  Committee 
for  Mental  Hygiene,  and  a  member  of  the  Finance  Com- 
mittee until  his  death,  and 

Whereas,  From  the  beginning,  he  was  of  inestimable 
value  to  the  Committee  because  of  his  professional  knowl- 
edge and  sympathy ;  his  power  of  initiative ;  his  just  vision ; 
his  extraordinary  personal  magnetism  which  inspired  others 
with  his  own  enthusiasm;  and  his  unswerving  directness 
in  working  out,  one  by  one,  the  necessary  steps  for  the 
advancement  of  its  plans;    and 

Whereas,  His  power  and  nobiUty  of  character  will  be, 
it  is  hoped,  an  inspiration  to  his  successors  and  a  dominant 
force  as  long  as  it  exists; 


58  HENRY     B  A  I  R  D     F  A  V  I  L  L 

Therefore,  Be  It  Resolved,  by  the  National  Committee 
for  Mental  Hygiene,  in  convention  assembled,  in  the  City 
of  New  York,  State  of  New  York,  this  Seventh  day  of 
February,  191 7,  that  this  body  deeply  mourns  the  too 
early  death  of  this  great  physician,  big-hearted  man,  and 
devoted  servant  of  humanity,  while  it  rejoices  in  his  example 
and  influence. 

Be  It  Resolved,  That  a  copy  of  this  resolution  be  sent 
to  his  family  and  that  it  shall  be  entered  in  the  minutes  of 
this  meeting. 


LETTERS   EROM   ORGANIZATIONS 


LAKE  MILLS,   WLSCONSIN,   NEIGHBORvS 

FEELINO  thc'Ll  Dr.  Favill  has  lic]]jcd  us  as  a  neighbor- 
hood and  as  individuals,  we  wish  to  express  to  you 
our  appreciation  of  him,  and  our  sympathy  in  this 
great  loss  which  has  come  to  us  all. 

He  helped  us  to  work  together  and  to  work  for  the  best. 
He  was  interested  in  each  one  of  us. 

His  influence  will  go  on  and  the  neighborhood  will 
always  be  better  for  the  little  time  he  has  given  us. 

S.  W.  Favill  H.  W.  Faville 

W.  F.  Stiles  Ben  W.  Crump 

C.  M.  Beveridge  George  P.  White 

Benj.  F.  Berg  Jesse  W.  Crump 
J.  O.  Johnston 

THE   CENTRAL   ILLINOIS   CREAMERY 
MEN'S   CLUB 

It  was  with  great  regret  that  we  received  the  news  of 
the  death  of  Dr.  Henry  B.  Favill.  As  dair\^men  we  feel 
that  we  have  lost  a  tireless  champion  of  our  cause.  His 
manifold  interests,  of  which  the  dairy  industry  was  one, 
have  made  him  invaluable  to  the  Society,  and  in  his  passing 
we  have  sustained  the  loss  of  a  true  friend. 

The  Central  Illinois  Creamery  Men's  Club,  assembled 
in  Bloomington,  March  2d,  wish  to  express  their  deepest 
sympathy  to  the  family  of  Dr.  Favill,  and  to  take  this 
opportunity  to  acknowledge  their  appreciation  of  his  work, 
character,  and  life. 

F.    A.    JORGENSON, 

Champaign,  III.  Secretary. 

59 


6o  HENRY      BAIRD     FAVILL 


THE  BUSINESS  MEN'S  DAIRY  EXTENSION 
MOVEMENT  OF  ILLINOIS 

Mrs.  Henry  B.  Favill: 
Dear  Madam: 

The  undersigned  has  been  directed  by  the  Board  of 
Directors  of  the  Business  Men's  Dairy  Extension  Move- 
ment of  Illinois  to  convey  to  you  our  appreciation  of  the 
late  Dr.  Favill.  As  a  co-worker  he  was  endeared  to  us, 
and  we  feel  keenly  the  great  loss  we  have  all  been  called 
upon  to  accept. 

Please  permit  us  to  extend  to  you  the  deep  appreciation 
we  feel  for  having  been  permitted  to  come  in  contact  with 
so  noble  and  so  inspiring  a  character. 

Assuring  you  of  our  deepest  sympathy  in  your  bereave- 
ment, in  which  we  all  join,  I  beg  to  remain 

Yours  sincerely, 

Edward  K.  Slater. 
Chicago,  February  29,  1916. 


EASTERN  STATES  AGRICULTURAL  AND 
INDUSTRIAL  EXPOSITION 

Mrs.  H.  B.  Favill: 
My  dear  Mrs.  Favill: 

When  the  sad  news  of  the  Doctor's  death  reached 
Springfield  it  was  a  cause  of  public  mourning  among  the 
three  hundred  and  fifty  business  men,  who  have  known 
of  his  public-spirited  work  for  the  betterment  of  agriculture. 

We  were  very  greatly  disappointed  in  not  having  the 
privilege  of  hearing  his  words  of  advice  and  encouragement 
at  the  Great  New  England  Banquet  on  the  evening  of  the 


TRIIMJTTCS      A  N  f)      R  IC  S  O  f,  (J  T  I  O  N  S  6r 

14th.  Mr.  PniU  U)](\  11s  of  llic  Doctor's  illness,  and  his 
absence  was  keenly  felt. 

While  we  realize  in  a  way  what  the  death  of  Dr.  Favill 
means  to  his  own  family,  we  know  that  it  is  also  a  very 
great  public  loss.  Men  who  think  in  large  units  and  who 
dedicate  much  of  their  thought  and  substance  to  the  public 
good  are  all  too  few  in  number.  The  City  of  Springfield 
was  looking  forward  to  a  closer  acquaintance  with  him. 

At  a  meeting  attended  by  nearly  four  hundred  men 
yesterday,  a  resolution  of  condolence  was  passed,  and  I 
was  directed  to  convey  to  you  something  of  the  appreciation 
that  Springfield  men  entertain  for  the  memory  of  Dr.  Favill, 
and  extend  to  his  family  their  most  sincere  sympathy. 

Very  truly  yours,      t  t     -r. 

■^         -^  -^  Joshua  L.  Brooks, 

President. 
Springfield,  Mass.,  February  22,  1916. 


INSTITUTE  OF  MEDICINE 
Mrs.  Henry  Baird  Favill: 
My  dear  Mrs.  Favill: 

As  a  committee  appointed  by  the  Governors  of  the 
Institute  of  Medicine  for  this  special  purpose,  we  desire 
to  convey  to  you  and  to  your  son  the  deep  sympathy  felt 
by  the  Institute  in  the  loss  of  your  husband. 

We  desire,  further,  to  join  in  the  expressions  of  praise 
that  are  heard  on  all  sides  for  his  industry,  skill,  and  high 
standing  as  a  physician,  his  worth  as  a  man  and  friend,  his 
lofty  conception  and  efficient  performance  of  civic  duty. 

He  honored  us  by  becoming  one  of  our  charter  members. 
We  shall  have  spread  upon  our  records  a  sketch  of  his  life 
showing  his  many  activities,  his  numerous  services  to  medi- 
cine, his  self-sacrificing  efforts  to  uplift  the  standards  and 
practices  of  civic  life.  We  deplore  the  loss  of  a  member 
to  whom  w^e  had  confidently  looked  forward  for  wise  counsel 


62  HENRY      BAIRD     FA  V  ILL 

and  inspiring  participation  in  the  working  out  of  the  prin- 
ciples of  the  Institute. 

Very  sincerely, 

N.  S.  Davis 
Wm.  Allen  Pusey 
James  B.  Herrick 
Chicago,  June  5,  1916. 


ALUMNA  ASSOCIATION 

ST.    LUKE'S   HOSPITAL   TRAINING   SCHOOL 

CHICAGO 

Dear  Mrs.  Favill: 

Perhaps  you  alone  can  realize  what  we  the  graduates 
of  St.  Luke's  have  lost  with  the  falling  asleep  of  that  great 
soul,  so  dear  to  us  all.  Each  and  every  one  of  us  shares 
with  you  a  deep  personal  grief,  too  real  for  either  spoken 
or  written  words,  but  please  accept  our  love. 
Most  sincerely  yours, 

Eva  a.  Mack, 

Secretary. 
March  i,  191 6. 


THE   VISITING   NURSE   ASSOCIATION 
OF   CHICAGO 

My  Dear  Mrs.   Favill: 

The  members  of  the  Board  of  Directors  of  the  Visiting 
Nurse  Association  desire  to  express  to  you  and  your  son 
their  deepest  sympathy. 

For  many  years  the  Association  had  had  the  rare  priv- 
ilege of  holding  Dr.  Favill  as  its  most  valued  counselor 
and  friend.  His  sympathy  and  understanding  never  failed; 
his  broad,  wise,  temperate  counsel  helped  at  all  times  of 
difficulty. 


'J'  K  I  l{  U   r  IC  S      AN  I)      R  !•:  S  ()  L  U  T  I  O  N  S  63 

To  the  sui)crvisf)rs  and  (hitler  nurses  whr)  knew  and 
loved  liim  lie  was  a,  tower  of  slrenj^th,  and  especially  was 
this  true  with  Miss  I^"'olcy,  who  constantly  appealed  to  him 
for  advice. 

Out  of  our  great  love  and  reverence  for  him  and  deep 
sense  of  devotion  has  come  the  desire  to  set  our  standards 
even  higher  and  strive  for  those  ideals  of  citizenship  which 
were  so  preeminently  his,  showing  in  our  work  more  of  the 
devotion  and  self-sacrifice  which  made  his  life  a  splendid 
gift  and  a  glorious  memory. 

Yours  faithfully, 

Josephine  R.  Payson, 

Corresponding  Secretary. 
March  4,  1916. 


THE   THREE   ARTS   CLUB 
CHICAGO 

My  dear  Mrs.  Favill: 

The  Board  of  Managers  of  the  Three  Arts  Club  wish 
me  to  express  to  you  their  sincerest  sympathy  in  your 
great  sorrow. 

We  feel  we  have  lost  a  valuable  friend,  counselor,  and 
adviser  with  the  passing  away  of  Dr.  Favill.  Always 
willing  to  aid  and  give  untiringly  of  his  services  to  do  good, 
unto  others,  Dr.  Favill  was  a  friend,  indeed  to  the  Three 
Arts  Club.  That  one  so  needed  by  his  fellow  men,  so  help- 
ful and  thoughtful  of  the  comforts  of  others,  should  be 
called  so  suddenly  can't  be  explained.  We  only  know  that 
many  mourn  with  you  in  your  sorrow.     Believe  me. 

Sincerely  yours, 

Grace  Dixox, 

Recording  Secretary. 
March  4,  1916. 


64  HENRY     BAIRD     FA  V  ILL 


•      THE   ILLINOIS   SOCIETY   OF 
THE   COLONIAL   DAMES   OF  AMERICA 

My  dear  Mrs.  Favill: 

The  President,  the  members  of  the  Board,  and  each 
member  of  the  Society,  are  thinking  of  you  with  sorrowing 
hearts  in  these  days  of  your  great  grief. 

Everyone  is  grieving  with  you  and  your  son,  for  your 
husband  stood  for  all  that  was  fine  and  noble;  and  his 
valued  assistance  in  so  many  branches  of  usefulness  makes 
his  loss  an  irreparable  one  to  the  city,  as  well  as  to  those 
who  knew  him  intimately. 

To  you  and  to  your  son  upon  whom  this  great  sorrow 
falls  most  heavily,  the  members  of  the  Illinois  Society  of 
Colonial  Dames  send  their  deepest  sympathy. 

Cordially  yours, 

Katharine  Bayley, 

Corresponding  Secretary. 
February  28,  1916. 


ASSOCIATED   JEWISH   CHARITIES 

In  memory  of  the  dear  departed,  a  contribution  to  the 
Memorial  Flower  Fund  has  been  made  by  Mr.  and  Mrs. 
Julius  Rosenwald,  4901  Ellis  Avenue. 

The  name  of  the  loved  one  thus  remembered  will  be 
included  in  the  Memorial  Flower  Fund  List  in  the  next 
report  of  the  Associated  Jewish  Charities  of  Chicago. 

Julius  Rosenwald, 

President. 


PRESS   COMMENT 


Chicago  Tribune,  February  22,  1916.     Editorial. 

DR.    FAVILL 

A  MAN  who  leads  in  his  own  profession  is  accounted 
a  success.  Usually  men  are  not  big  enough  for  one 
profession.  Dr.  Henry  B.  Favill,  who  died  in  Spring- 
field, Mass.,  on  Sunday,  was  bigger  than  his  profession.  He 
succeeded  in  relating  his  profession  intimately  to  life,  and 
he  had  enough  energy  to  do  work  outside  of  his  profession. 

Quite  characteristically,  he  died  in  the  performance  of 
one  of  these  extra-professional  duties.  He  went  to  Spring- 
field to  address  the  New  England  Dairy  Association.  Dr. 
Favill  knew  from  his  profession  the  dangers  of  impure  milk. 
He  did  not  merely  warn  against  milk.  He  established  a 
model  farm  in  Wisconsin  and  attempted  to  work  out  prac- 
tical means  for  avoiding  impure  milk. 

It  was  the  same  in  politics.  Dr.  Favill  was  not  content 
to  see  and  understand  the  dangers  of  impure  politics  in 
Chicago.  He  went  out  and  worked  against  them.  For 
three  years  he  was  president  of  the  Municipal  Voters' 
League. 

Chicago  can  get  along  without  men  like  Dr.  Favill. 
But  it  cannot  get  ahead  without  them. 


Chicago  Herald,  February  22,  1916.     Editorial. 

A   GOOD    CITIZEN    PASSES 

IN  the  death  of  Henry  Baird  Favill  Chicago  has  suffered 
a   heavy-   loss.     Dr.    Favill   was   a  modern  represent- 
ative of  the  old-fashioned  doctor,  "guide,  philosopher 
and  friend." 

65 


66  HENRY     BAIRD     FA  V  ILL 

But  greater  than  the  personal  bereavement  is  the  loss 
which  has  come  to  the  entire  community.  For  Henry 
Baird  Favill  was  also  the  citizen  ever  loyal  to  the  public 
welfare.  By  birth  and  professional  attainments  his  lot  was 
cast  with  the  prosperous.  He  might  easily  have  been 
blinded  by  his  great  success.  He  might  have  been  merely 
the  eminent  physician,  the  friend  of  the  great. 

He  chose  a  higher  place.  No  class  was  big  enough  for 
him.  His  interest  and  his  service  belonged  to  all  groups. 
The  mere  recital  of  the  agencies  and  organizations  which 
he  touched  indicates  something  of  the  generosity  of  his 
outlook.  He  was  a  pioneer  in  public  health  betterment, 
in  civic  reform  and  in  social  readjustment.  He  was  a  fore- 
runner in  the  creation  of  the  new  conscience. 

But  the  things  he  did  were  the  bare  shell  of  the  man. 
Larger  than  any  of  his  activities  was  the  unselfish  spirit 
which  animated  them  all.  He  was  an  interpreter.  The 
rich  and  the  powerful  were  better  able  to  sympathize  with 
the  urgencies  and  the  demands  of  other  classes  because  so 
many  believed  "what  Dr.  Favill  says  is  right."  Chicago 
has  in  truth  lost  a  man  whose  presence  can  ill  be  spared. 
Citizens  of  his  temper,  of  his  zeal  for  the  common  good, 
are  all  too  few  in  any  place  and  any  time. 


Chicago  Evening  Post,  February  22,  19 16.     Editorial. 

DR.    HENRY   B.   FAVILL 

DR.  HENRY  B.   FAVILL  was  a  man  who  held  in 
a  city  of   over   2,000,000  inhabitants  the  position 
of   love,    dignity    and    influence   held   by   many   a 
lesser-known  "country  doctor"  in  the  villages  of  America. 
That  was  the  thing  that  made  his  life  unique. 
Dr.   Favill  as  a  physician  stood  among  the  very  few 
very  best   in   the   country.     His   profession   will   miss  his 
leadership.     Households   and   hospitals   today  will  hardly 


r  R  I  B  U  T  E  S      AND      R  I<:  S  O  L  U  T  I  O  N  S  67 

know  where  to  turn  in  order  to  fill  tlic  j^rijj  left  by  his 
death. 

He  had  not  only  the  keenest  teehnieal  abihty  but  the 
finest  quahties  of  character.  That  straight,  angular  figure, 
without  overcoat  even  in  the  coldest  weather,  brought 
physical  confidence  to  the  bed.side  of  the  weakest  invalid. 
There  was  something  psychologically  compelling  in  Dr. 
Favill's  sturdy  pride  in  the  strain  of  natii^e  Indian  blood 
that  ran  through  his  veins.  It  made  him,  perhaps,  even 
more  of  the  crisp  out-of-doors  man  that  is  so  welcome  a 
presence  in  the  sick  chamber. 

Dr.  Favill's  life  would  have  been  completed  in  service 
had  he  contained  it  within  these  limits.  But,  like  those 
faithful,  hard-working  "country  doctors,"  he  gave  of  his 
power  and  ability  to  the  common  welfare  of  his  city.  He 
served  as  president  of  the  Municipal  Voters'  League  from 
1907  to  1 910,  during  the  period  when  it  was  finally  estab- 
lishing the  standing  on  which  it  rests  today,  secure  against 
all  efforts  to  undermine  public  confidence  in  it.  He  was 
president  of  the  City  Club.  No  sound  effort  of  honesty 
and  solid  advance  in  government  ever  found  him  unwilling 
to  take  his  share  in  it. 

Dr.  Favill's  life  thread  will  be  found  running  through  the 
fabric  of  his  city's  history  for  the  last  two  decades.  It  has 
brightened  it  and  strengthened  it.  Dr.  Favill's  sudden 
death,  in  the  full  swing  of  his  splendid  activity,  leaves 
Chicago  with  more  than  the  customary  sense  of  a  deep 
public  loss. 

Chicago  Tribune,  Februar}'^  26,  1916.     Correspondence. 

"AND  THE  GREATEST  OF  THESE   IS   LOVE" 

WHO  shall  take  his  place?     What  shall  we  do  with- 
out  him?"  came   from   many   lips   on   Tuesday 
morning  at  the  Fourth  Presb^^terian  church  when 
hundreds  of  sorrowing   people,   3-oung  and  old,   rich   and 


68  HENRY     BAIRD     FA  V  ILL 

poor,  were  gathered  to  pay  their  last  respects  to  Dr.  Henry 
Baird  Favill.  It  was  his  great  happiness  to  do  for  others. 
He  had  a  firm  beHef  in  the  good  of  each  one  of  us  and  he 
knew  and  taught  that  "inner  peace  that  can  only  come 
from  within."  So  it  was  to  the  spiritual  as  well  as  the 
physical  ills  that  he  ministered,  leading  each  one  to  some 
moral  victory. 

He  was  a  man  of  many  sides  and  his  delightful  wit  and 
bouyancy  of  spirit  were  in  striking  contrast  to  his  deep, 
meditative  moments.  He  was  a  giant  in  stature,  as  well 
as  in  intellect  and  heart,  and  his  courage  and  strength 
were  combined  with  the  tact  and  intuition  of  a  woman. 
He  had  great  adaptability  and  fitted  easily  into  any  en- 
vironment, for  he  understood  the  minds  and  the  hearts 
of  men. 

As  a  medical  man  he  advised  the  use  of  little  medicine, 
had  no  fads,  and  was  not  didactic  as  to  diet  ("food  is  food," 
he  often  said).  He  wanted  people  to  make  an  ideal  of 
health,  to  try  to  be  well  for  health's  sake,  and  not  just  to 
avoid  being  ill. 

He  advocated  work  for  all  and  feared  the  menace  of 
the  easy  life.  He  despised  all  idleness,  sham,  and  osten- 
tation, and  deplored  all  waste  and  extravagance.  While 
his  spontaneous  mind  admitted  of  no  fixed  rules,  his  enor- 
mous capacity  for  work  was  made  practicable  because  of 
the  perfect  system  of  his  plans.  He  had  none  of  the  usual 
horror  of  the  thought  of  old  age  and  spoke  of  looking  for- 
ward to  the  "peace"  of  that  time;  but  he  was  snuffed  out 
in  his  mature  prime,  in  the  full  vigor  of  his  powers,  when  he 
was  most  needed.  It  is  good  to  feel  that  he  has  found 
that  peace  and  that  he  rests  from  his  labors.  It  is  a. 
triumph  to  die  so  beloved.  Chicago  has  and  will  have 
other  great  men,  but  it  will  never  have  another  Dr. 
Favill.— G.  S.  S. 

Chicago,  Feb.  24,  1916.  . 


T  R  I  B  i;  T  K  S      AND      K  lO  S  O  L  C  T  I  O  N  S  69 


Chicago  Daily  News,  Febnuiry  26,  19 16.     By  (iraham  Tayh^r. 

FROM    AN   ARTICLE   ON   THE    MUNICIPAL 
VOTERS'    LEAGUE 

IN  the  midst  of  them  one  name  and  form  rises  higher 
than  the  others  because  this  week  we  have  lost  him 
from  among  us,  and  his  character  and  achievements 
stand  in  the  clear.  Dr.  Henry  B.  Favill  was  the  fifth  president 
of  the  Municipal  Voters'  League,  but  we  now  call  his  name 
first  on  the  roll.  When  a  new  leader  was  needed  it  did  not 
seem  possible  that  this  most  eminent  physician,  completely 
preoccupied  with  his  large  and  lucrative  practice,  could  be 
persuaded  to  undertake  this  public  trust.  But  he  did,  not 
only  willingly,  but  glad  of  the  opportunity  to  serve  his 
fellow  citizens. 

Why  did  he  do  it?  What  was  there  in  it  for  him  except 
the  work  and  worry  through  two  hard  years  and  their 
bitter  city  election  contests?  He  could  do  it  only  by  ac- 
cepting less  professional  business,  only  by  the  loss  of  much 
of  his  income. 

He  suffered  this  loss  because  not  only  could  he  not 
take  as  much  new  business,  but  lost  some  former  patrons 
on  account  of  the  stand  he  took  to  protect  the  city's  interest 
against  those  who  sought  private  gain  at  public  expense. 
Worse  still,  he  had  to  defend  himself  against  an  infamous 
conspiracy  to  defame  him,  whereby  the  enemies  of  the 
league  sought  to  discredit  its  findings  against  them.  Wh}^ 
did  he  bear  and  do  all  this?  Chicago  is  the  answer.  He 
loved  his  town.  He  cared  for  his  fellow  citizens.  He  had  a 
pride  in  the  city's  progress.  He  felt  he  owed  it  something. 
He  wanted  to  bear  his  full  share  of  its  burdens.  He 
wanted  to  share  a  better  Chicago.  What  else  could  have 
moved  such  a  man  to  such  service  as  he  rendered  our  city? 

Not  only  the  success  of  the  Municipal  Voters'  League  in 
getting  a  better  Cbuncil,  but  also  the  founding  of  the  City 


70  HENRY      BAIRD     FAVILL 

Club  to  train  its  2,300  members  in  effective  citizenship 
and  to  influence  the  poHcies  of  the  city  and  the  estab- 
lishment of  the  Bureau  of  Public  Efficiency  to  check  up 
and  standardize  our  city's  accounts  and  departmental 
service  —  these  are  the  expressions  which  he  himself  gave 
of  the  motives  which  moved  him. 

In  shameful  contrast  stand  the  sordid  perversions  of 
our  whole  civil  service  in  the  interest  of  party  and  personal 
gain,  which  sink  lower  in  infamy  as  Dr.  Favill's  name  rises 
higher  on  the  city's  scroll  of  fame. 


Minneapolis  Journal,  March  5,  1916.     Editorial. 

CHICAGO   AND   DR.    FAVILL 

A  MAN  died  in  Chicago  the  other  day  who  was  an 
ornament  to  human  nature.  He  had  been  im- 
mensely successful,  but  his  obituaries  were  not  in- 
spired by  the  respect  which  the  world  has  for  success. 
They  were  written  by  appreciation  and  by  gratitude. 

His  career  was  truly  remarkable.  Dr.  Henry  Baird 
Favill,  as  the  Chicago  Evening  Post  remarks,  performed  in 
a  community  of  more  than  two  million  souls  the  function 
of  the  country  physician.  It  may  be  added  that  the  manner 
of  his  performance  was  as  remarkable  as  the  fact  that  he 
did  perform  such  a  function  for  the  fourth  city  of  the  world. 

He  was  one  of  the  foremost  physicians  in  the  United 
States.  His  worldly  material  success  was  very  great. 
But  the  true  distinction  of  the  man,  amounting  to  a  genius, 
was  human.  It  was  what  he  was  to  a  multitude  of  indi- 
viduals, who  suffered,  who  were  in  trouble.  His  was  the 
care  not  only  of  bodies  but  also  of  souls.  And  he  failed 
nobody  who  sought  him,  though  men  and  women  of  every 
class  and  estate  and  sort  sought  him.  He  was  spiritual 
supporter  to  a  whole  weak  brotherhood  and  sisterhood. 

Dr.  Favill  was  a  man  of  science  and  had  no  illusions. 
He   knew  what    the  race  is,   and  he   had  not   a  trace  of 


T  R  r  M  (T  T  l<:  S      AN  F)      F^  K  S  O  F.  (J  T  F  C)  N  S  71 

sentimentalisni  in  Ins  composition.  I'nt,  he  helped  every- 
body, anybody.  And  Ihe  stuff  of  his  help  was  the  l^est  on 
earth.  Contaet  with  his  strength  inspired  strength,  and 
insincerity  was  shamed  in  his  stalwart  presence.  It  is  an 
old  figure,  but  that  man  was  a  tower. 

"The  good  great  man,"  as  the  poet  Coleridge  knew,  is 
the  best  product  of  the  long  evolutionary  process.  vStrong 
men  are  not  always  kind,  and  l<ind  men  are  not  always  wise. 
But  the  profit  to  a  community  of  a  life  such  as  this  man 
lived,  is  inestimable.  Chicago  peculiarly  was  favored  by 
his  presence.  He  is  dead  at  fifty-six,  and  we  suppose  there 
has  been  wider  unofficial  grief  and  more  poignant  sense  of 
loss  among  individuals  of  that  community  than  ever  there 
has  attended  the  death  of  any  man. 

Chicago  Tribune,  June  1,1916. 

PLAN    DR.    FAVILL   MEMORIAL 

Committee   Is   Organized  under  the  Auspices  of 

City  and  Commercial  Clubs  to 

Work  on  Project 

UNDER  the  auspices  of  the  City  Club  and  the  Com- 
mercial Club  a  committee  has  been  organized  to  es- 
tablish a  memorial  to  Dr.  Henry  Baird  Favill.  The 
form  which  the  memorial  will  take  has  not  yet  been  deter- 
mined, but  it  is  expected  that  this  will  shortty  be  done,  and  a 
fuller  statement  of  the  committee's  plan  will  then  be  made. 
The  committee  will  not  solicit  contributions,  but  hopes 
that  sums  may  be  received  for  this  purpose  amounting  in 
the  aggregate  to  not  less  than  $250,000. 

The  members  of  the  committee  are  Edgar  A.  Bancroft, 
Cyrus  Bentley,  Dr.  Frank  Billings,  ]Mrs.  Emmons  Blaine, 
Dr.  E.  C.  Dudley,  Dr.  Frank  Gunsaulus,  E.  D.  Hulbert, 
Dr.  Harry  Pratt  Judson,  Cyrus  H.  ]\IcCormick,  Allen  B. 
Pond  and  William  E.  Skinner. 


MAGAZINE   NOTICES 


Manufacturers^  News,  February  24,  1916. 

DEATH   OF   HENRY   B.    FAVILL 

IN  the  death  of  Dr.  Henry  B.  Favill,  the  community 
suffered  a  distinct  loss,  not  only  of  a  physician  of  excep- 
tional attainments  but  of  the  finest  type  of  American 
citizen.  He  conceived  it  his  duty  to  give  a  large  portion  of 
his  richly  endowed  mentality  and  his  time  —  crowded  though 
he  was  with  the  demands  of  his  profession  —  to  civic  right- 
eousness and  the  amelioration  of  the  lot  of  those  whose 
lives  had  not  been  fortunate. 

Dr.  Favill  did  excellent  service  for  three  years  as  presi- 
dent of  the  Municipal  Voters'  League,  as  president  of  the 
Chicago  City  Club  and  as  a  member  of  the  Public  Effi- 
ciency Bureau.  He  was  a  real  reformer.  Dr.  Favill  never 
departed  a  hair's  breadth  from  what  he  considered  right 
and  just  and  in  the  interest  of  the  greatest  number,  but  his 
manner  was  so  courteous  and  sympathetic  and  diplomatic 
that  he  won  admiration  and  friends  among  those  who  did 
not  invariably  agree  with  his  conclusions  instead  of  the 
bitter,  uncompromising  antagonism  which  is  so  often 
aroused  by  reformers  of  a  narrow  type  whose  capacity  for 
inspiring  hatred  is  greater  than  their  ability  to  win  friend- 
ship and  respect. 

Dr.  Favill  died  last  Sunday,  at  the  home  of  a  friend  in 
Springfield,  Mass.,  following  a  sudden  attack  of  pneumonia, 
contracted,  it  is  believed,  through  attending  the  funerals 
of  John  J.  Herrick  and  C.  L.  Allen,  two  old  friends  who 
had  succumbed  to  the  same  disease. 

72 


T  R  F  lU  J  T  I-:  S      AND      R  FC  S  O  F.  FJ  T  F  f)  N  S  73 


JouniiU  (if  lite  A  mcricdn  Mcdiail  As.s(i( ialioi,  l''i'l>ru.'iry  26,  \()i(>. 

HENRY   BAIRD    FAVILL 

DR.  Henry  B.  Favill,  whose  obituary  appears  elsewhere 
in  this  issue,  was  an  unusual  man.  As  a  physician 
he  represented  modern  scientific  medicine,  and  his 
practice  was  large.  He  took  active  part  in  the  work  of  local, 
state  and  national  societies,  and  when  he  discussed  scientific 
medical  questions  he  was  listened  to  as  one  speaking  v/ith 
authority.  However,  while  his  interest  in  medicine  was 
great  and  his  practice  large,  his  interest  in  social  questions 
and  in  public  welfare  was  so  extensive  as  to  make  his  medi- 
cal work  seem  almost  incidental.  As  a  citizen  of  Chicago 
he  was  intimately  identified  with  those  forces  which  are 
seeking  to  bring  about  purity  and  efficiency  in  public  works 
and  service.  He  was  one  of  the  moving  spirits  in  the 
organization  of  the  City  Club  —  an  institution  which  has 
done  much  to  bring  about  better  conditions  in  Chicago. 
He  did  effective  work  as  chairman,  and  executive  officer, 
of  the  Municipal  Voters'  League  of  Chicago,  which  posi- 
tion he  occupied  for  three  years.  During  that  time  he 
naturally  made  many  enemies,  but  in  spite  of  the  attacks 
made  on  him  by  ward  politicians  and  others,  he  emerged 
from  this  work  with  reputation  unspotted.  He  was  a  man 
of  altruistic  ideals,  but  at  the  same  time  was  practical: 
he  attacked  all  problems  with  a  broad  conception  of  human- 
ity and  its  weaknesses.  With  absolute  unselfishness,  he 
accepted  leadership  in  many  movements  which  he  knew 
would  bring  on  him  attacks  b}^  those  injured.  As  chair- 
man of  the  Council  on  Health  and  Public  Instruction,  his 
advice  was  regarded  as  that  of  a  man  who  looked  at  the 
problems  not  alone  from  the  standpoint  of  the  physician, 
but  also  from  that  of  the  publicist.  As  the  Chicago  Herald 
said,  "No  class  was  big  enough  for  him.  His  interest  and 
his  service  belonged  to  all  groups.     The  mere  recital  of  the 


74  HENRY      BAIRD      FAVILL 

agencies  and  organizations  which  he  touched  indicates 
something  of  the  generosity  of  his  outlook.  He  was  a 
pioneer  in  public  health  betterment,  in  civic  reform  and  in 
social  readjustment.  He  was  a  forerunner  in  the  creation 
of  the  new  conscience."  We  need  more  of  the  spirit  that 
controlled  Dr.  Favill  in  his  activities ;  he  stood  for  the  ideal 
that  the  responsibilities  of  citizenship  rest  more  on  the 
medical  profession  than  on  any  other  class. 

The  AlumncB  of  St.  Luke's,  March,  1916.     By  a  Pupil  Nurse. 

DR.    FAVILL 

WE  may  not  stand  with  those  who  mourn  your  burial, 
The  work  goes  on  and  duty  holds  us  here. 
But  in  our  hearts  our  tribute  we  would  bear, 
And  say  our  last  farewell,  oh,  friend ! 

The  city  mourns  her  loss  — 
Ten  thousand  of  the  suffering  and  the  sick 
Remember  now  your  kindness  and  your  care. 
By  night  and  day  you  watched  and  worked 
And  gave  your  very  life  to  lesson  others'  pain. 

But  we,  the  nurses  of  St.  Luke's,  more  happy  in  our  fate. 
Were  wont  to  work  with  you  and  know  your  plan, 
And  do  some  little  part  with  you 
To  make  men  whole  again. 

And  year  by  year  you  watched  us  as  we  came  and  worked 

and  went, 
Our  interest  at  your  heart. 
You  gave  us  courage,  knowledge,  strength. 
And  best  of  all,  your  own  great  kindliness. 

Too  soon  death  claimed  you  from  us, 

While  life  was  rich  and  strong  and  there  was  much  to  do 

And  we  hoped  for  great  things  from  you. 

The  leader  of  our  Board. 


TKIHUTICS      AND      K  i:  S  O  L  (J  T  I  O  N  S  75 

Farewell,  oh,  rest  at  last. 
And  live  again  in  memory, 
Loved,  trusted  and  revered. 
Our  strong  and  noble  friend. 
February  21,   1916. 

Harvester  World,  March,  19 16. 

WE   LOSE   A   FRIEND 

DR.  Henry  Baird  Favill,  who  addressed  the  last  public 
dinner  of  the  Harvester  Club,  died  after  a  short  ill- 
ness at  Springfield,  Massaehusetts,  Sunday,  February 
20th.     Literally,  he  died  a  martyr  to  his  devotion  to  duty. 

We  are  proud  to  think  of  Dr.  Favill  as  a  typical  western 
man.  Born  in  Wisconsin  fifty-seven  years  ago,  educated 
at  the  State  University  at  Madison,  taking  his  medical 
degree  here  at  Rush  Medical  College,  he  became  the  lead- 
ing general  practitioner  of  medicine  in  this  city,  with  a 
fame  extending  over  the  whole  country.  The  man  who 
enters  the  medical  profession  as  a  general  practitioner 
abandons  thoughts  of  personal  comfort.  He  goes  at  all 
hours,  in  all  weathers,  to  all  classes.  And  this  was  Dr. 
Favill.  His  stalwart  physical  frame  was  dominated  by 
his  splendid  mind.  In  every  attitude  and  attribute  he  gave 
evidence  of  power;  and  it  was  power  fitly  used  for  the 
good  of  his  fellowmen.  Many  hours  taken  from  his  busy 
professional  life  were  spent  in  efforts  to  correct  the  short- 
comings or  worse  of  government  and  political  conditions. 
His  great  force  of  character,  his  independence  of  judgment, 
courage  of  conviction,  his  noble  disinterestedness,  his 
tender-hearted  sympathy,  were  freely  given  to  his  friends 
and  the  communit}'-.  No  man  was  too  humble,  and  none 
too  mighty  for  his  service. 

Taken  in  the  midst  of  his  career,  we  cannot  feel  that  his 
work  was  done.  He  was  the  type  of  manhood  for  young 
men  to  emulate,  and  older  men  could  profit  by  his  example. 


76  HENRY      BAIRD     FA  V  ILL 

Few  men  have  such  outstanding  quahties  as  to  be  long 
missed  in  the  busy  hfe  of  the  world;  but  here  was  one  of 
such  conspicuous  value  that  it  seems  the  gap  of  his  passing 
can  never  be  filled. 


Kimball's  Dairy  Farmer,  March  i,  1916. 

DR.    HENRY   B.    FAVILL 

UNTIRING  in  his  manifold  duties;  sincere  in  his  con- 
victions; fearless  in  his  speech  for  everything  help- 
ful and  good  —  such  was  the  character  of  Dr.  Favill, 
president  of  the  National  Dairy  Council,  who  died  February 
20th  at  Springfield,  Mass.  His  death  was  due  to  an  attack 
of  pneumonia  contracted  a  week  before.  Though  he  did 
not  feel  his  best  he  was  anxious  not  to  disappoint  the  New 
England  Dairymen's  Association,  who  had  placed  him  on 
the  program.  His  illness  took  a  severe  turn  immediately 
upon  his  arrival  and  the  address  was  never  delivered.  He 
died  three  days  later. 

During  the  eight  years  of  his  connection  with  agri- 
cultural matters,  he  has  commanded  the  respect  of  his 
fellow  workers  and  the  masses  whom  he  was  serving.  His 
interest  in  all  things  was  of  the  genuine  sort.  From  his 
profession  he  not  only  knew  the  value  of  milk  as  a  food, 
but  also  the  dangers  of  impure  milk.  He  preached  the  one 
and  warned  against  the  other.  He  established  in  Wis- 
consin a  farm  on  a  practical  basis  and  solved  to  his  own 
satisfaction  the  essentials  in  the  production  of  clean  milk. 
Thus  he  was  sincere  and  thorough  in  all  things.  He  had 
the  powerful  character  so  rarely  met  with  in  this  day  and 
age  where  commercialism  walks  hand  in  hand  with  all 
movements  for  advancement.  He  was  a  man  whose  great- 
ness would  have  made  itself  felt  in  a  still  larger  measure  in 
the  years  to  come,  when  agricultural  development  will  have 
reached  its  real  momentum. 


TRIBUTIOS      AND      K  i;  S  O  F.  ( '   I   I  O  N  S  77 

Men  oi  Dr.  I^^ivill's  build,  both  physical  and  mental, 
are  few.  To  realize  more  fully  the  capacity  of  this  man's 
mind,  one  must  become  acquainted  with  the  manifold 
duties  he  took  upon  himself.  Aside  from  practicinj^  medi- 
cine he  was  deeply  interested  in  every  movement  of  ujjlift 
and  sane  reform.  For  years  he  served  the  Municipal 
Voters'  League  of  the  City  of  Chicago  as  president,  success- 
fully fighting  dirty  politics  and  in  more  recent  years  giving 
much  of  his  time  to  the  betterment  of  living  conditions. 
He  was  on  innumerable  committees  of  social  uplift  and  gave 
each  duty  the  attention  required.  His  excellent  record  as 
president  of  the  Dairy  Council  and  director  of  the  National 
Dairy  Show  is  too  well  known  to  require  further  comment. 
Dr.  Favill  thoroughly  studied  all  problems  and  announced 
his  conclusions  fearlessly. 

What  the  editor  of  the  Chicago  Tribune  said  of  Dr. 
Favill  and  his  worth  to  Chicago  can  well  be  quoted  in  re- 
gard to  his  worth  to  agriculture:  "Agriculture  might  be 
able  to  do  without  men  like  Dr.  Favill,  but  it  cannot  well 
get  ahead  without  them." 

Brownell's  Dairy  Farmer,  March  i,  1916. 

DAIRY   INDUSTRY   LOSES   A   GOOD   FRIEND 
IN    DR.    H.    B.    FAVILL 

MICHIGAN  folks  are  not  generally  aware  of  the  fact 
that  in  the  death  of  Dr.  Henrys  Baird  Favill  of  Chi- 
cago, the  dairy  industry  of  this  country  has  lost  an 
invaluable  friend.  A  few  Michigan  men  ma}"  know  him 
as  vice-president  of  the  Holstein  Friesian  Association  of 
America,  but  the  thousands  of  other  dairy^men  in  this 
State  have  never  heard  of  him  either  as  a  Holstein  breeder 
or  as  a  loyal  worker  for  the  advancement  of  the  dair^^ 
industry. 

Dr.  Favill  was  one  of  the  most  able  members  of  the 
medical  profession  of  this  country,  yet  he  came  to  his  death 


78  HENRY      BAIRD     FAVILL 

while  on  his  way  to  address  a  meeting  of  the  New  England 
Dairy  Association.  This  active,  powerful  man  of  middle 
life,  who  had  acquired  enough  of  fame  and  wealth  in  his 
profession  to  enable  him  to  live  the  remainder  of  his  life 
at  ease,  succumbed  to  an  attack  of  pneumonia  while  doing 
what  he  believed  to  be  his  duty  as  a  dairyman.  It  is  not 
difficult  to  understand  devotion  to  the  dairy  cause  from 
those  who  have  their  worldly  all  wrapped  up  in  a  herd  of 
cows,  but  it  is  something  fine  and  noble  for  a  man  of  Dr. 
Favill's  wealth  and  medical  standing  to  give  so  freely  to  this 
cause  that  his  death  came  directly  as  a  result.  Not  all  of 
the  martyrs,  as  is  popularly  supposed,  are  among  the  lowly, 
either  in  dairying  or  in  any  other  line  of  human  endeavor. 

The  death  of  Dr.  Favill,  at  this  time,  comes  as  a  hard 
blow  to  a  great  project  in  which  he  was  devoutly  interested. 
This  is  the  National  Dairy  Council  of  which  he  was  presi- 
dent. As  our  friends  who  have  read  these  pages  may 
remember,  the  National  Dairy  Council  is  an  organization 
of  persons,  engaged  in  all  branches  of  the  dairy  industry, 
who  are  seeking  to  bring  about  a  more  prosperous  condi- 
tion in  the  industry.  Of  late  the  activity  of  the  Council 
has  been  concentrated  on  a  plan  of  advertising  dairy  prod- 
ucts throughout  the  country  for  the  purpose  of  increasing 
consumption  and  thereby  prices  paid  to  producers.  Dr. 
Favill  was  one  of  the  most  active  promotors  of  this  plan. 
His  address  to  the  New  England  dairymen  was  to  have 
concerned  itself  chiefly  with  the  efforts  now  being  made 
by  the  Council  to  create  an  annual  advertising  fund.  His 
enthusiasm,  wide  knowledge  of  affairs,  and  keen  insight 
into  the  needs  of  the  dairy  industry  of  to-day,  enabled  him 
to  become  a  powerful  influence  in  furthering  this  purpose 
of  the  Dairy  Council. 

His  place  as  leader  will  be  filled  somehow  from  the  ranks 
of  those  who  followed  his  soldierly  figure  in  the  cause  of 
more  profitable  dairying.  In  after  years,  when  the  dairy 
industry  has  become  one  in  which  a  fair  reward  is  returned 


TKFFUJTES      ANT)      R  I'.  S  O  I,  ( J  I   I  O  N  S  79 

for  one's  efforts,  let  us  rememlK;r  lliat  \)r.  Ifcnry  Haird 
Favill  was  the  first  leader  in  tlie  present-day  effort  to  bring 
about  that  condition. 

The  New  Republic,  March  4,  1916. 

DR.    FAVILL 

THE  mystery  of  raeial  traits  is  emphasized  at  the  death 
of  Dr.  Henry  Baird  Favill  of  Chicago.  Mainly  of 
white  stock,  there  was  Indian  blood  in  Dr.  Favill,  and 
it  is  for  his  semblance  to  a  group  leader  and  chief  that  he 
will  long  be  remembered.  He  was  active  and  eminent  as  a 
medical  man  not  only  in  a  wide  private  practice,  but  as 
a  lecturer,  a  consultant,  and  a  leading  spirit  in  local  and 
national  medical  organizations.  But  it  was  in  his  personal 
and  communal  relations  that  he  was  most  felt.  His  mag- 
nificent rugged  physique  suggested  the  group  chieftain. 
This  was  fully  borne  out  by  his  superb  vitality,  his  accessi- 
bility, his  wisdom  of  the  heart.  He  had  that  character 
common  to  all  big  personalities,  the  inspiring  suggestion  of 
a  free  and  unqualified  natural  force.  He  kept  in  Chicago 
the  personal  touch  with  his  patients  that  was  natural  to 
his  practice  in  Wisconsin,  but  he  established  a  similar 
valuable  relation  to  Chicago  in  politics,  civics,  education, 
and  humane  organization.  Publicity  has  much  to  do 
with  popularity.  Some  popularity  is  nine-tenths  publicity. 
But  Dr.  Favill's  was  a  popularity  founded  on  realities. 
For  all  the  complex  and  anonymous  character  of  the  modern 
city,  his  spirit  will  march  on  in  the  places  that  knew  him, 
very  much  as  the  memory  of  a  tribal  chief. 

The  Breeders'  Gazette,  March  9,  1916. 

THE   LATE   DR.    FAVILL 

HENRY  BAIRD  FAVILL  served  well  his  day  and 
generation.     Death  certainly  loved  a  shining  mark 
when  its  shaft  struck  him  down  at  the  apex  of  his 
career    of   public    service.     An    American   of    the    highest 


So  •  HENRY     BAIRD     FAVILL 

type,  boasting  the  trace  of  Indian  blood  which  gave 
him  striking  physical  distinction  in  any  company,  edu- 
cated for  eminent  service,  his  vigorous  young  manhood 
quickly  ripened  into  a  career  which  gave  him  first  rank 
among  the  physicians  of  Chicago,  a  commanding  emi- 
nence in  the  nation's  medical  circles,  and  brought  him 
into  a  field  of  usefulness  in  the  dairy  cattle  breeding  in- 
dustry of  recent  years  which  was  yielding  rich  and  far- 
reaching  results. 

His  early  years  were  spent  in  unsparing  service  in  the 
medical  profession.  Few  men  have  climbed  so  quickly 
into  eminence  in  the  profession,  but  such  natural  gifts  as 
Dr.  Favill  possessed,  utilized  with  singleness  of  purpose 
for  humanity's  sake,  could  not  have  unfolded  a  less  con- 
spicuous career.  As  a  practitioner  in  the  homes  of  the 
leading  citizens  of  Chicago,  and  as  a  lecturer  in  its  eminent 
medical  colleges,  Dr.  Favill  has  written  pages  of  permanent 
history  in  the  profession. 

As  a  publicist  he  was  scarcely  less  distinguished.  He 
was  a  born  leader,  and,  entertaining  the  highest  ideals  of 
civic  life,  he  rendered  high  service  to  Chicago  at  a  time 
when  its  civic  ideals  had  fallen  to  a  low  ebb  by  reason  of 
the  activities  of  the  vicious  and  the  indifference  of  the  better 
element.  When  he  was  asked  how  he  could  find  time  amid 
the  pressure  of  his  professional  duties  for  such  work,  he 
replied  simply  that  he  felt  an  obligation  toward  the  public 
life  of  Chicago  which  he  must  discharge. 

His  services  in  professional  and  public  life  are  history. 
His  helpfulness  to  the  dairy  cattle  industry  was  in  the 
making.  As  soon  as  his  financial  condition  permitted, 
he  began  to  indulge  his  innate  love  for  land  and  live  stock, 
and  no  keener  pleasure  ever  came  into  his  life  than  that 
derived  from  his  dairy  farm.  His  heart  was  in  it,  and  as 
often  as  he  could  steal  away  from  the  demands  of  his  prac- 
tice he  found  his  greatest  satisfactions  in  life  in  the  company 
of  stock  breeders   and  on  his  Wisconsin  farm.     He  was 


TRIJJUTRS      AND      K  i:  S  O  I.  U  T  I  O  N  S  8i 

Vice-President  of  the  Holstein-Friesian  Association  of  Am- 
erica and  would  have  become  its  President  at  the  June 
meeting.  His  broad  vision  gave  form  and  character  to 
the  National  Dairy  Council,  of  which  he  was  President, 
and  he  had  projected  through  that  organization  plans 
which  arc  pregnant  with  benefit  to  the  dairy  industry. 

Personally  he  was  the  most  charming  of  men.  Culti- 
vated in  the  schools  and  universities,  poHshed  by  the  attri- 
tion of  the  higher  walks  of  professional,  financial,  and 
social  life,  he  was  typical  of  the  modern  gentleman  who 
excels  the  traditional  gentleman  of  the  old  school,  because 
his  opportunities  have  been  greater  for  the  development 
of  the  graces  and  courtesies  of  a  real  gentleman. 

And  he  was  "Harry"  to  his  friends,  who  loved  him. 
Simplicity,  loyalty,  and  service  were  the  keys  to  the 
character  of  this  man,  whose  departure  has  left  the  world 
poorer  in  its  possession  of  full-made  men. 


Wisconsin  Alumni  Magazine,  April,  191 6. 

HENRY   B.   FAVILL 

HOW  like  a  giant  oak  he  constant  stood. 
His  face  forever  turned  to  meet  the  blast ; 
The  sturdy  trunk  rising  to  Heaven's  light, - 
Faith  in  the  Future, — Wisdom  in  the  Past. 

The  Woodman  now  has  felled  the  massive  tree ; 
On  Mother  Earth  its  branches  softly  lie; 
What  a  sad  void  doth  mark  the  landscape  fair 
When  monarchs  full  of  life,  like  him,  must  die. 

Beneath  the  sheltering  arms  rooted  and  grew^ 
Full  many  a  tender  shoot  to  vigorous  age ; 
He  drew  the  lightning's  blow,  the  thunder's  crash 
And  saved  the  weaker  things  from  Nature's  rage. 


82  HENRY     BAIRD     FA  V  ILL 

But  'cross  the  fallen  oak  now  streams  the  sun, 
And  smaller  trees  and  seedlings  thrive  anew, — 
So  the  warm  life  he  fostered  brings  its  fruit 
To  crown  his  life,  so  noble,  tried  and  true. 

F.  D.  SiLBER,   '94. 


The  Open  Air  Smile,  February,  1917. 

ONE   OF   CHICAGO'S   GREAT   MEN — 
DR.    HENRY   BAIRD   FAVILL 

THIS  month  when  we  are  honoring  two  great  Americans 
it  is  fitting  that  we  pay  tribute  to  one  of  our  own  great 
men  of  Chicago  —  Dr.  Henry  Baird  Favill,  who  was 
taken  from  his  field  of  activity  just  a  year  ago. 

Against  the  background  of  patriotism  which  this  month 
creates,  the  figure  of  Dr.  Favill  stands  out  as  a  true  Amer- 
ican. Every  citizen  of  Chicago  —  every  boy  and  girl  in  the 
schools — owes  Dr.  Favill  a  real  debt,  for  he  spent  his 
energies  unceasingly  in  the  interest  of  the  best  things  for 
the  community.  The  Civic  Creed,  which  the  boys  and 
girls  of  the  open  air  schools  know  so  well,  was  truly 
expressed  in  Dr.  Favill's  life:  "We  want,  therefore,  to  be 
true  citizens  of  our  great  city,  and  we  will  show  our  love 
for  her  by  our  works.  Chicago  does  not  ask  us  to  die  for 
her  welfare;  she  asks  us  to  live  for  her,  and  so  to  live  and 
so  to  act  that  her  government  may  be  pure,  her  officers 
honest,  and  every  corner  of  territory  shall  be  a  place  fit  to 
grow  the  best  men  and  women  who  shall  rule  over  her." 

In  this  spirit.  Dr.  Favill  worked  zealously  for  a  better 
city,  believing  that  it  was  the  duty  of  every  citizen  to  give 
his  best  to  his  country  and  community  and  that  only  in 
this  way  would  our  city  and  national  government  be  carried 
on  honestly  and  for  the  interest  of  all. 

He  held  himself  and  his  profession  as  a  public  trust, 
working  with  devotion  for  the  good  of  humanity. 


T  R  I  15  U   I' I-:  S      AND      R  IC  S  O  I.  IJ  T  I  O  N  S  83 

The  spirit  of  Washington  and  Lincoln,  whom  we  honor 
to-day  for  tlicir  devotion  to  their  country  in  her  hour  of 
great  trouble,  moved  also  this  ^reat  man  of  Chicago,  who 
in  the  doing  of  his  duty  toward  his  fellowmen  and  the 
community  from  day  to  day  exemplified  the  kind  of  patri- 
otism that  every  boy  and  girl  will  be  expected  to  show  as 
a  citizen.  Not  long  before  he  was  called  away,  Dr.  Favill, 
in  addressing  a  gathering  at  which  he  was  the  guest  of  honor, 
said:  "Never  in  the  history  of  this  country  has  it  Vjeen 
so  imperative  that  every  honest,  able-bodied,  red-V>looded, 
clear-thinking  man  should  have  his  mind  set  on  what  is  the 
right  thing  for  him,  for  his  community,  and  for  his  country 
to  do." 

Dr.  Favill  was  admired  and  loved  by  all  who  knew  him, 
mingling  with  the  strength  of  mind  that  matched  his  giant- 
like stature,  a  gentleness  and  sympathy  that  made  him 
the  friend  of  man  and  leader  among  men.  He  was  most 
human  in  his  sympathies,  never  finding  it  too  much  trouble 
to  be  of  service  to  those  who  sought  him  —  and  these  were 
many,  for  his  genial  and  commanding  personality  drew 
people  to  him  from  all  walks  of  life. 

One  time  a  group  of  people  were  talking  with  Dr.  Favill 
about  their  ancestors,  how  and  when  they  came  to  America, 
and  where  from.  Someone  asked  him  whether  his  ancestors 
came  on  the  Mayflower  or  on  the  Speedwell.  Dr.  Favill 
said,  "No,  but  some  of  them  were  on  the  reception  com- 
mittee that  welcomed  the  people  who  did  come  on  these 
ships."  This  was  his  way  of  telling  them  of  the  fine  strain 
of  Indian  blood  that  w^as  in  his  veins,  and  which,  perhaps, 
helped  to  explain  his  love  for  the  woods  and  fields  and  for 
the  great  out-of-doors. 

He  truly  loved  the  out-of-doors.  It  was  a  joy  to  see 
him  swing  along  the  street,  head  erect,  chest  thrown  out, 
and  his  nostrils  fairly  joying  in  the  air  which  he  seemed  to 
love  to  take  into  ever}^  portion  of  his  lungs.  He  walked  a 
great  deal,  and  even  if  he  was  on  the  crowded  streets  of  a 


84  HENRY      BAIRD     FAVILL 

great  city  his  mind  would  take  him  to  the  fields  and  moun- 
tains, and  he  evidently  got  his  clear  mind  and  his  great 
vision  and  judgment  from  being  able  to  learn  the  lessons 
from  nature,  just  as  we  read  that  certain  wise  men  of  old 
were  those  who  took  care  of  their  flocks  by  day  and  night 
on  the  hills,  and  who  studied  the  stars  to  know  the  time 
and  to  get  their  directions  and  to  learn  the  mysteries  and 
beauty  of  the  heavens. 

As  a  most  skillful  physician,  he  threw  the  force  of  his 
splendid  mind  against  the  unhappiness  and  suffering  caused 
by  disease.  He  filled  a  large  place  in  our  city  and  nation, 
working  with  many  organizations  to  improve  the  physical 
and  social  conditions  of  mankind.  As  a  part  of  his  program 
for  good  health  for  the  city  he  worked  to  establish  bathing 
beaches,  parks  and  playgrounds  where  throngs  of  grown- 
ups and  children  may  play  in  the  out-of-doors. 

He  was  very  much  interested  in  everything  that  would 
make  people  strong  and  healthy  and  happy.  And  he  knew 
that  the  way  to  do  this  was  to  begin  with  the  boys  and  girls. 
He  was  interested  in  the  schools,  for  he  knew  that  all  the 
boys  and  girls  must  go  there,  and  he  wanted  the  teachers 
and  the  school  board,  and  everybody  that  was  responsible 
for  their  education,  to  be  sure  that  they  had  fresh  air  and 
exercise  and  good  advice  about  health  habits.  He  thought 
the  school  ought  to  be  sure  to  help  give  the  children  good, 
strong,  healthy  bodies  as  well  as  trained  minds.  He  be- 
lieved heartily  in  the  open  air  schools,  and  from  their  very 
beginning  in  Chicago  he  was  their  friend,  and  the  adviser 
of  those  directly  connected  with  them. 

Not  only  because  he  was  our  good  friend,  working  for 
all  the  best  things  that  will  make  for  happy,  healthy  lives, 
but  because  we  wish  to  do  honor  to  one  of  Chicago's  greatest 
men,  we  dedicate  this  number  of  the  Open  Air  Smile  to  Dr. 
Favill. 

The  greatest  tribute  we  can  pay  him  is  to  hope  that  we 
may  learn  to  live  nobly  as  he  lived,  to  love  our  fellowmen 


TRIIMJTF'-.S      A  N  F)      R  I'  S  f)  F.  IJ  T  I  f)  N  S  S5 

as  he  ]f)vc(]  1,hojn,  and  to  value  the  best  things  in  life  as  he 
valued  them. 

At  the  memorial  meeting,  held  in  the  City  Club  last 
year,  lines  from  Edwin  Markham's  "Lincoln"  were  read 
as  a  tribute  to  Dr.  Favill,  which  have  double  significance 
for  this  number  of  our  j^aper: 

The  color  of  the  ground  was  in  him,  the  red  earth; 

The  tang  and  color  of  the  primal  things  — 

The  rectitude  and  patience  of  the  rocks; 

The  gladness  of  the  wind  that  shakes  the  corn; 

The  courage  of  the  bird  that  dares  the  sea; 

The  justice  of  the  rain  that  loves  all  leaves; 

The  pity  of  the  snow  that  hides  all  scars; 

The  loving  kindness  of  the  wayside  well; 

The  tolerance  and  equity  of  light, 

That  gives  as  freely  to  the  shrinking  weed 

As  to  the  great  oak  flaring  to  the  wind  — 

To  the  grave's  low  hill  as  to  the  Matterhorn 

That  shoulders  out  the  sky. 

He  held  his  place  — 
Held  the  long  purpose  like  a  growing  tree  — 
Held  on  through  blame  and  faltered  not  at  praise. 
And  when  he  fell  in  whirlwind,  he  went  down 
As  when  a  kingly  cedar  green  with  boughs, 
Goes  down  with  a  great  shout  upon  the  hills 
And  leaves  a  lonesome  place  against  the  sky. 


86  HENRY     BAIRD     FAVILL 


DR.    FAVILL'S   FUNERAL 

CYRUS  McCORMICK,  Edgar  Bancroft,  and  Dr.  Dud- 
ley assumed  the  large  task  of  arranging  for  Dr.  Favill's 
funeral  in  Chicago,  and  in  this  way  took  from  the  grief- 
stricken  family  a  burden  which  they  will  never  forget. 
The  service  was  held  in  the  Fourth  Presbyterian  Church, 
Lincoln  Parkway  and  Delaware  Place,  in  the  forenoon  of 
February  22,  1916.  The  church  was  entirely  filled,  largely 
with  prominent  Chicago  men,  and  Rev.  Dr.  Frank  W. 
Gunsaulus  presided.  After  music  and  a  brief  scriptural 
selection,  he  read  Bryant's  "Thanatopsis."  The  Rev. 
John  Faville,  a  cousin  of  the  Doctor's,  offered  prayer.  A 
special  train  had  been  provided  by  Mr.  McCormick  which 
then  took  a  large  number  to  Madison,  Wis.,  for  the  burial. 
There  Mr.  C.  H;  Tenney  had  kindly  made  all  arrange- 
ments. The  party  was  driven  out  to  Forest  Hill,  where 
Rev.  E.  G.  Updike,  assisted  by  Rev.  John  Faville  and  Rev. 
Henry  Faville,  spoke  the  last  words.  The  Chicago  friends 
then  returned  to  the  special  train  and  home. 

The  active  pallbearers  were:  Wheaton  Augur,  Gerald 
M.  Butler,  F.  Goddard  Cheney,  Dr.  Nathan  S.  Davis,  Jr., 
Dr.  Frederick  A.  Jefferson,  George  Richardson,  Dr.  Eugene 
S.  Talbot,  Jr.,  Henry  Favill  Tenney,  and  Horace  Kent 
Tenney,  Jr. 

The  honorary  pallbearers  were:  E.  A.  Bancroft,  Cyrus 
Bentley,  Dr.  Frank  Billings,  Dr.  F.  H.  Blatchford,  W.  J. 
Calhoun,  Dr.  Charles  P.  Clark,  J.  M.  Dickinson,  Dr.  J.  M. 
Dodson,  Dr.  E.  C.  Dudley,  Victor  Elting,  Kellogg  Fair- 
bank,  J.  J.  Glessner,  Frank  Hamlin,  Dr.  Ludvig  Hektoen, 
Dr.  Henry  Hooper,  E.  D.  Hulbert,  David  B.  Jones,  Frank 
H.  Jones,  Dr.  Thomas  H.  Lewis,  Cyrus  H.  McCormick, 
R.  B.  Ogilvie,  Allen  B.  Pond,  Frank  H.  Scott,  and  John 
W.  Scott. 


TRii5uri<;s    AND'    K  i<:so  L  IJ  T  r  ON  S  87 


THE    HENRY    B.    FA  VI  LI.   SCHOOL 
OF   OCCUPATIONS 

AY  a  meeting  of  tin-  Illinois  vSocicty  for  Mental  Hy- 
giene, of  which  Dr.  Favill  was  the  first  vice-presi- 
dent, held  on  Wednesday,  October  24,  191 7,  it  was 
decided  to  name  the  occupational  department  of  the  society 
"The  Henry  B.  Favill  School  of  Occupations." 

This  department  was  started  as  an  experiment,  in  1914, 
largely  to  serve  as  a  clearing  house  for  cases  of  doubtful 
insanity  which  the  courts  considered  as  showing  promise  of 
return  to  usefulness  if  given  a  proper  environment  and 
trade.  In  the  last  three  years  many  charitable  organiza- 
tions have  come  to  depend  upon  the  department  for  dealing 
with  the  chronic  misfits  of  society  —  the  famil}'  head  who 
has  the  wrong  job  and  is  doing  poorly  —  the  ne'er-do-well 
with  a  latent  talent  to  be  discovered  —  the  bewildered  for- 
eigner driven  practically  to  mania  by  misunderstandings. 
Such  cases,  which  seem  to  hold  phases  of  mental  mal- 
adjustment, are  carefully  studied  under  advice  of  medical 
experts  and  helped  to  a  satisfactory  solution. 

This  work  has  so  far  been  limited  to  Chicago.  Now, 
by  request  of  the  State  Criminologist  and  the  State  Alienist, 
teachers  are  being  trained  for  use  in  insane  hospitals,  prisons, 
and  reform-schools  throughout  Illinois. 

In  view  of  the  success  attained  in  many  cases  of  merely 
physical  handicap,  the  department  has  been  appealed  to 
for  training  of  specially  selected  groups  of  volunteers  for 
service  in  military  convalescent  hospitals.  Such  classes  are 
being  sent  by  the  Red  Cross  and  by  the  Home  Charities 
Department  of  the  Women's  Committee,  State  Council  of 
Defense,  Illinois  Division.  The  necessity  for  this  type  of 
work  has  been  showm  in  Canada,  where  it  was  stated 
recently  that  1,000  such  trained  volunteers  were  needed. 


88  HENRY     BAIRD     FAVILL 

As  the  work  had  its  beginning  in  his  office;  as  it  was 
largely  due  to  his  steadying  and  wise  counsel  and  constant 
interest  during  the  hard  formative  years  that  the  work 
has  grown  to  its  present  usefulness;  and  as  sympathy, 
understanding,  kindliness,  science,  and  common  sense  — 
all  so  essential  to  this  work — were  so  characteristic  of 
Dr.  Favill,  it  seems  peculiarly  fitting  that  this  department 
should  bear  his  name. 

(Signed)     Anna  Hamill  Monroe, 
President,  Illinois  Society  for  Mental  Hygiene. 

REPORT   OF   THE   MEMORIAL   COMMITTEE 

[It  was  hoped  that  the  report  from  the  committee  (seep.  71), 
organized  by  the  City  and  Commercial  clubs  to  propose  a  memo- 
rial for  Dr.  Favill,  would  be  finished  in  time  to  be  included  here. 
The  report,  however,  is  not  quite  completed,  but  when  ready  will 
be  mailed  to  all  who  receive  this  book.  Inquiries  may  be  sent  to 
Mr.  Edgar  a.  Bancroft,  606  South  Michigan  Avenue,  Chicago.] 


PART   TWO 


ADDRESSES    AND    PAPERS 


I.    MEDICINE   AND   PUBLIC   HEALTH 


PART   TWO 

Addresses  and  Papers 

I.    MEDICINE   AND    PUBLIC    HEALTH 
DIET   AND   DISEASE 

[Date  and  occasion  of  writing  unknown.] 

I  THINK  I  should  falter  before  presenting  to  an  audi- 
ence of  even  kindly  men  a  fragment  of  reflection  so 
distinctly  suggestive  of  my  shop  were  I  in  the  least 
responsible  for  my  subject.  I  fancy  that  your  committee 
saw  fit  to  take  no  chances  of  my  exposure  to  general  dis- 
section by  limiting  me  to  a  field  which  few  have  willingly 
entered.  I  do  not  propose,  however,  to  forego  the  modest 
assertion  that  this  is,  of  all  topics  of  human  interest,  the 
most  important.  This  statement  harmonizes  well  with  the 
shop.  Moreover  I  demand  that  he  who  points  his  finger 
of  scorn  at  this  rather  commonplace  matter  should  have 
smooth  joints,  whereby  to  demonstrate  his  elevation. 

It  ought  to  require  no  argument,  that  man  originally 
ate  to  live,  and  the  inference  is  not  remote  that  he  usualty 
deserved  what  he  got.  With  the  foreshadowing  of  modern 
license  occurring  in  the  Garden  of  Eden  we  need  not  struggle 
now. 

Nothing  can  be  more  perfect  than  the  automatic  adjust- 
ment of  supply  and  demand  found  in  the  quest  of  primitive 
man  for  food.  Never  has  civilizing  man  ventured  to  tamper 
with  that  relation  without  paying  the  penalty.  I  am  asked 
to  discuss  the  mitigation  of  these  penalties  as  related  to 
the  taking  of  food,  particularly  from  the  standpoint  of  the 
physician. 

The  complex  system  of  functions  whereby  life  is  main- 
tained is  finally  incumbent  upon  one  factor,  the  possibility 

91 


92  HENRY     BAIRD     FA  V  ILL 

of  introducing  extraneous  material  into  organic  union.  Life 
implies  energy  and  energy  implies  dissipation,  and  to  any 
individual  life  such  dissipation  is  waste.  Hence,  waste  and 
repair  come  to  be  correlative  terms  which  cover  the  whole 
of  vital  experience.  Their  equation  may  not  be  greatly 
disturbed  without  disaster.  It  becomes  necessary  there- 
fore to  provide  means  for  appropriation  of  material  for 
food,  and  the  proposition  is  at  once  involved. 

Let  us  reflect  that  the  process  of  digestion  is  a  series  of 
destructive  acts  whereby  the  very  complicated  substances 
of  which  our  food  consists  are  split  up  into  simpler  forms, 
from  which  are  built  new  chemical  structures,  which  are 
in  turn  broken  down,  or  more  properly  burned  down,  and 
discarded  as  ash. 

To  the  physiologist  the  food  problem  is  one  of  chemical 
constituents  rather  than  physical  forms.  The  atmosphere, 
air,  is  to  him  as  distinctly  a  food  as  that  which  is  eaten; 
the  gains  and  losses  through  the  skin  as  pertinent  as  the 
more  obvious  exchanges.  Hence,  to  satisfy  a  critical  in- 
quiry the  entire  ingesta  of  an  individual  must  be  accounted 
for  with  mathematical  exactness  by  definite  formulae. 

The  organs  necessary  to  these  transformations  are  many ; 
the  functions  of  each  well-defined;  their  adaptability  to 
imperfect  conditions  limited.  Hence,  upon  the  integrity 
of  various  organs  must  rest  the  value  of  the  complicated 
series,  called  metabolism. 

Nowhere  is  more  obvious  the  relation  of  a  chain  to  the 
weakest  link,  for,  though  we  have  frequently  joint  and 
coordinate  function,  we  have  virtually  no  vicarious  function. 
Each  step  in  the  great  act  of  assimilation  therefore  is  essen- 
tial. Each  organ  must  pass  on  to  its  successor  a  product 
fitly  transformed,  or  the  balance  of  activities  becomes  dis- 
turbed. Thus,  either  the  function  of  the  recipient  organ 
is  not  performed,  or  it  is  performed  at  such  disadvantage 
as  perhaps  to  determine  its  own  premature  degeneration. 
Hence,  it  is  very  obvious  that  the  importance  of  any  default 


MIC  Die  I  NIC      AND      IM'I'.I,  If      IIP.  ALT  II  93 

in  a  given  vilnl  process  must  he  dcLcnnincd  by  a  perspective 
view,  in  wliich  the  intrinsic  flaw  may  be  frequently  sub- 
ordinate to  the  burden  of  compensation  devolving  upon 
succeeding  factors  in  the  nutritive  sequence.  All  of  this 
proceeds  automatically  under  normal  conditions,  present 
and  historical. 

Immediate  normal  conditions  arc  hard  to  define,  but  are 
closely  dependent  upon  the  maintenance  of  the  relation  of 
supply  and  demand.  If  this  ratio  be  normal,  health  will 
result,  providing  the  further  law  of  selection  he  allowed  to 
operate.  It  is  in  the  historical  aspect  that  the  most  in- 
flexible limitations  occur.  Consider  that  the  smallest  physi- 
ological trait,  the  most  obscure  nutritive  vice,  may  be  as 
transmissible  as  facial  features  or  mental  quality;  that 
these  may  appear  in  offspring  intensified  actually  by  breed- 
ing or  relatively  by  aggravation  of  conditions  of  life.  Re- 
flect that  the  tendency  of  civilization  is  to  determine  both 
conditions,  and  one  is  forced  to  acknowledge  that  he  owes 
much  to  his  ancestors. 

Digestion  of  food  is  of  course  fundamental  to  nutrition. 
Yet,  as  we  regard  the  term  as  applying  to  the  primary'  acts 
whereby  food-stuffs  are  rendered  soluble,  it  is  a  very  limited 
part  of  the  process.  Food  which  has  been  properly  and 
completely  digested  as  a  primary  act  is  utterly  unfit  to  be 
taken  into  the  blood  and  circulated.  It  requires  further 
transformation,  taking  place  variously  back  to  more  nearly 
its  original  form  to  avoid  the  curious  circumstance  that  in 
its  fully  digested  state  it  is  actually  a  poison.  Given,  how- 
ever, its  fitting  digestion  and  transformations,  which  may 
be  termed  secondary  digestion,  it  has  but  entered  upon  its 
mission  as  pabulum. 

It  is  in  part  stored,  in  part  passed .  on  for  immediate 
appropriation  —  by  what?  By  every  individual  cell  of  the 
organism;  and  here  is  the  great  unexplored  territory-. 
What  happens  within  the  limits  of  the  microscopic  cells, 
each  one  a  living  thing  capable  of  all  the  requirements  of 


94  HENRY     BAIRD     FA  V  ILL 

self-support,  must  remain  largely  in  doubt.  However,  it 
is  clear  that  in  this  final  distribution  of  food  through  the 
circulating  blood,  in  the  complex  chain  of  activities  covered 
by  the  terms  growth,  repair  and  excretion,  taking  place 
constantly  in  every  cell,  there  resides  the  all  important 
relation  of  food  to  organism. 

Of  one  fact  we  are  aware  which  furnishes  perhaps  the 
most  definite  guide  to  our  physiological  conclusions.  The 
processes  whereby  energy  is  liberated,  reparative  inter- 
change takes  place,  and  effete  material  is  discharged,  in- 
volve oxidation.  The  comparison  to  a  heating  apparatus 
is  exceedingly  apt.  The  three  elements  of  absolute,  cor- 
relative dependence,  are  fuel,  combustion,  and  ash. 

Whatever  of  virtue  may  reside  in  food  or  its  preparation, 
its  value  to  the  economy  must  be  considered  strictly  in  the 
light  of  the  combustion  facilities  of  the  body.  The  needs 
of  the  tissues  determine  for  the  most  part  the  rate  of  oxid- 
ation, and  these  needs  are  themselves  determined  by 
cellular  depletion  resulting  from  physiological  discharges 
of  energy.  Hence,  the  inseparability  of  food  and  work  in 
this  discussion. 

The  systematic  demand  for  food  is  the  criterion  by  which 
to  gauge  the  indulgence  in  food  and  unfortunately  bears 
little  relation  to  appetite.  Hence  the  complexity  of  a  fun- 
damental question  which  involves  the  interpretation  of 
facts  and  conditions,  apparently  irrelevant. 

It  is  not  an  unfair  question,  why  this  combustion  process 
is  so  essential.  Assuming  the  oxidation  as  the  best  known 
of  the  chemical  changes  which  food  undergoes,  we  may 
assert  that  two  important  facts  exist.  First,  that  the  prod- 
ucts of  incomplete  oxidation  are  in  themselves  noxious  and 
hence  a  menace,  and  second,  that  the  incomplete  changes  in 
the  food  diminish  its  fitness  for  excretion,  presenting  to  the 
excretory  organs  products  which  cannot  be  eliminated,  or 
are  eliminated  with  difficulty  and  imperfectly.  Hence  we 
encounter  two  things:    the  circulating  medium  surcharged 


M  IC  I)  I  C  I  N  K      AN  I)      P  T:  P,  L  I  C      l\  K  A  f.  T  If  95 

with  unCil,  ni.Licn'al,  and  organs  of  relief  struggling  with  an 
abnormal  requirement.  Tliis  l)rings  us  to  the  question  of 
elimination. 

P'^ew  of  us  realize  how  constantly  and  to  what  degree  we 
depend  for  life  iij)on  the  ])CTformance  of  our  eliminating 
organs.  It  is  marvelous,  in  the  light  of  all  vicissitudes, 
that  more  destruction  does  not  occur  at  this  point. 

Consider  that  every  being  incessantly  elaborates  poisons, 
which  accumulating  to  a  sufficient  degree  in  the  system 
produce  disease.  Such  poisons  are  as  incessantly  discharged 
through  the  emunctories,  but  were  this  absolutely  to  cease 
for  even  a  comparatively  few  hours,  the  burden  of  toxemia, 
as  we  say,  would  be  fatal.  From  this  extreme  result  through 
all  the  shades  of  influence  to  the  least  severe,  we  find  failure 
to  eliminate  at  the  bottom  of  vast  amounts  of  disorder. 
That  this  failure  to  excrete  may  be  due  to  several  conditions 
is  to  be  inferred  from  the  preceding  discussion;  but  whether 
the  retention  of  waste  is  the  consequence  of  damaged  or 
inefficient  excretory  tissue,  or  of  antecedent  breaks  in  the 
nutritive  process,  whereby  the  waste  should  be  changed  to 
a  form  fit  for  selection  by  the  organs  of  elimination,  the 
result  is  systemic  poison  by  products  of  intrinsic  activity. 

It  is  apparent,  therefore,  that  there  becomes  established 
a  vicious  circle  under  such  conditions,  wherein  a  final  ex- 
cretory defect  determines  a  toxemia  which  aggravates  each 
preceding  vice. 

Food  is  the  ultimate  stumbling  block  in  all  of  these 
perverted  functions.  The  necessity  to  take  food,  the  essen- 
tial transformations  through  which  it  must  pass,  and  the 
physical  incapacity  to  effect  these  indiscriminately,  furnish 
the  grounds  of  the  therapeutic  struggle  which  is  called 
dietetic. 

There  is  a  vagueness  of  conception  as  to  the  essential 
character  of  a  so-called  "diet"  which  is  truly  remarkable. 
There  is  likewise  a  uniformity  of  expression  and  of  phrase- 
ology which  is  most  unique.     This  is  to  be  remarked  no 


96  HENRY     BAIRD     FA  V  ILL 

less  with  the  profession  than  the  laity.  The  question  has 
not  as  yet  passed  the  point  of  arbitrary  schedule.  Its  new- 
ness is  e\'idenced  by  the  narrowness  of  the  path  which 
traverses  it. 

We  discover  plenty  of  physicians  advanced  enough  to 
prescribe  diet  for  the  fat,  the  lean,  the  gouty,  the  nervous, 
the  phlegmatic,  and  so  on,  but  as  yet  we  must  admit  the 
mild  impeachment  that  the  prescriptions  are  more  nearly 
uniform  than  the  highest  grade  of  therapeutic  analysis  would 
really  demand.  On  the  other  hand  it  is  to  be  said  that  the 
principles  underlying  the  adaptation  of  food  materials  to 
given  physical  demands  are  so  few  and  simple  that  apparent 
sameness  easily  occurs. 

The  individual  peculiarities  which  distinguish  one  clinic- 
al picture  from  another  often  disappear  when  reduced  to 
their  ultimate  causation.  It  is  the  ability  to  reduce  a  mor- 
bid process  to  its  simplest  terms,  to  select  from  a  tangle 
of  symptoms  the  important  thread,  and  follow  it  to  its 
end,  which  marks  the  diagnostician.  It  is  as  true  here  as 
elsewhere  that  accurate  diagnosis  is  a  most  necessary  foun- 
dation for  a  therapeutic  procedure.  People  fail  to  grasp 
the  importance  of  this  fact;  fail  to  credit  the  profession 
with  desire,  and  especially  with  the  ability  to  satisfy  this 
requirement;  fail  to  recognize  the  dignity  of  a  considerate 
avowal  of  ignorance. 

Recently,  a  man  said  to  me,  ' '  My  physician  has  not  been 
able  to  make  up  his  mind  what  ails  me,  but  the  druggist 
told  me  right  away  and  gave  me  some  medicine."  Wily 
tradesman,  who  knew  too  well  that  the  average  man  de- 
mands action  rather  than  reflection! 

A  specific  diet  may  be  indicated  for  either  of  several 
conditions,  which  will  in  general  fall  into  four  more  or  less 
distinct  classes: 

1.  Diet  selected  for  the  correction  of  defects  or  vices 
in  primary  digestion. 

2.  Diet  with  regard  to  defective  secondary  digestion. 


MIC  Die   INK      AND      PUBLIC      IIEAr.Tff  97 

3.  Diet  in  cases  where  there  has  been  excessive  intake. 

4.  Diet  to  accommodate  decreased  elimination. 

In  the  first  will  be  included  many  forms  of  so-called 
indigestion,  and  dyspepsia.  The  varieties  of  indigestion 
are  many  and  although  presenting  indications  of  disturb- 
ance in  common,  to  be  vSeparated  by  careful  analysis  into 
distinct  groups.  There  occurs  a  failure  of  digestion  which 
should  go  on  in  the  stomach,  so-called  gastric  indigestion. 
For  this  occurrence  there  are  many  causes  —  (a)  failure  to 
secrete  efficient  digestive  fluid,  (b)  secretion  of  too  much 
or  perverted  gastric  juice,  (c)  inactivity  of  the  muscular 
apparatus  of  the  stomach,  (d)  various  distinct  disease  condi- 
tions, for  the  most  part  catarrhal  or  ulcerative,  which  offer 
more  or  less  obstacle  to  digestion  and  are  themselves  very 
responsive  to  digestive  conditions.  Such  conditions  are 
quite  usually  associated  with  some  degree  of  consequent 
mal-nutrition.  The  defect  is  at  the  fountain  head;  the 
process  fails  whereby  the  inert  matter  of  the  outer  world 
is  transformed  into  usable  material,  and  a  proportionate 
starvation  results.  Such  are  the  greatest  dangers  of  infancy. 
In  the  adult  the  prospect  is  rather  of  distress  than  of  disaster. 

Unfortunately  these  negative  conditions  are  aggravated 
by  positive  complications.  If  food  does  not  go  properly, 
it  goes  very  objectionably.  It  has  no  tendenc}^  to  be  simply 
neglected.  The  changes  in  food  which  is  not  digested  are 
by  far  the  most  urgent  in  their  demand  for  correction. 
Fermentation  and  all  that  depends  thereon  is  the  usual 
event. 

The  diet  appropriate  to  any  such  cases  is  variable.  Not 
infrequently  it  is  tentative,  because  of  insufficient  knowledge 
as  to  exact  requirements.  In  general,  however,  it  must 
conform  to  three  requirements.  It  must  be,  (i)  unirri- 
tating,  (2)  subdivided,  that  is  mechanically  accessible,  and 
(3)  such  as  to  leave  the  least  residuum  favorable  to  fermenta- 
tions of  the  type  in  especial  question. 

Failure  of  the  stomach  to  carr}'  on  its  part  in  digestion 
5 


98  HENRY      BAIRD     FAVILL 

is  perhaps  the  least  serious  of  digestive  defects.  At  inter- 
vals more  or  less  irregular  the  stomach  unloads  itself  into 
the  intestine.  By  so  doing  it  accomplishes  for  its  own 
relief  what  we  imitate  often  in  practice.  It  discharges  its 
contents  more  or  less  digested  into  a  viscous  whose  powers 
are  similar  though  much  greater. 

Amongst  other  functions  it  is  the  work  of  the  intestine 
to  assume  the  digestion  where  it  is  left  by  the  stomach,  and 
complete  it.  It  is  possible  for  the  intestine  to  accomplish 
the  whole  act  from  the  beginning.  Hence  the  default  of 
the  stomach  is  mitigated  by  the  broad  capacities  of  the 
intestine.  To  any  degree  in  which  it  performs  more  work 
than  is  normal,  because  of  gastric  failure,  its  act  is  always 
vicarious.  Beyond  this,  its  function  is  to  digest  all  of  the 
food-stuffs  which  reach  it  up  to  that  time  untouched. 

Foods  are  of  three  general  classes,,  (i)  Proteid,  by  which 
is  meant  albumens,  meat,  eggs,  etc.,  (2)  Carbohydrate,  in- 
cluding starches  and  sugars,  (3)  Hydrocarbon  or  fat.  Of 
these  the  stomach  can  digest  only  the  proteid  to  any  con- 
siderable extent,  but  no  end  of  outside  influence  may  affect 
the  starches  and  fats  while  in  the  stomach  awaiting  a  further 
stage,  and  the  propriety  of  introducing  them  into  the  diet 
of  stomach  disease  depends  quite  upon  the  variety  of  gastric 
disease. 

Intestinal  indigestion  it  will  be  seen  is  possibly  of  much 
more  serious  importance.  Its  normal  functions  are  broad 
and  the  importance  thereof  great.  It  is  not  to  be  relieved 
or  its  defects  repaired,  by  the  act  of  any  successor.  The 
conditions  which  are  grouped  under  the  general  term  in- 
testinal indigestion  are  in  fact  several,  furnishing  a  field 
for  great  diagnostic  acumen.  Here,  as  in  the  stomach,  the 
questions  involved  are  those  of  nutritive  lack  on  the  one 
hand,  and  irritative  decomposition  of  residual  food  on  the 
other.  The  former  may  be  the  efficient  cause  of  great 
bodily  failure,  the  latter  the  irritative  step  leading  to  far 
reaching  disease. 


MEDICINE     AND      IMJ  IM.  I  C      iri«:A[.'IH  90 

The  selection  of  food  for  the  reh'cf  of  these  intestinal 
conditions  constitutes  our  most  satisfactory  means  of  treat- 
ment. Because  of  the  fact  that  it  is  a  final  process  with 
no  auxiliary  successor,  the  course  ordinarily  pursued  varies 
from  that  pursued  with  the  refractory  stomach.  In  the 
case  of  the  stomach  we  are  inclined  to  put  upon  it  legitimate 
burdens,  freeing  it  from  the  embarrassment  of  incidental 
vices,  and  depending  upon  the  intestine  to  make  good  any 
shortcomings.  In  the  case  of  the  intestine  we  are  inclined 
to  spare  all  burden  possible,  forcing  the  stomach  to  its 
highest  pitch  with  a  view  to  relieving  the  intestine  of  worry. 
All  food  fermentation  tends  to  produce  disease  of  the  sur- 
faces which  include  it.  Hence,  for  a  further  reason  we 
seek  to  avoid  undigested  residue,  which  introduces  the 
second  class  of  dietetic  problems  occurring  in  the  course  of 
what  I  have  termed,  quite  arbitrarily,  secondary  digestion. 

Previously  it  was  stated  that  proteid  food  which  has 
been  fully  digested  in  the  stomach  or  intestines  in  the 
so-called  peptone  stage,  is  unfit  to  enter  the  blood  for  general 
distribution.  It  must  be  transformed  to  a  condition  chem- 
ically much  nearer  to  the  form  from  which  it  started.  In  a 
measure  the  same  is  true  of  starches  and  fats.  This  re- 
markable and  really  protective  function  resides  in  two  or- 
gans, to  what  extent  parallel  in  powers  is  uncertain.  These 
are  the  liver,  which  all  food  traverses  before  entering  the 
general  circulation,  and,  more  especially,  the  intestinal  wall, 
which  all  food  stuff  must  penetrate  before  it  can  be  regarded 
as  within  the  body.  In  the  course  of  this  simple  penetra- 
tion it  is  now  conclusive  that  the  most  important  changes 
occur  of  the  nature  just  referred  to.  Physiological  chemis- 
try fails  us  at  this  interesting  point  so  that  we  have  not 
knowledge  of  the  chemical  changes  which  normally  take 
place,  but  clinically  we  know  that  upon  the  integrity  of  the 
mucous  membrane  of  the  intestine  depends  in  great  part 
the  chance  of  secondary  digestion.  Hence  the  gravity  of  in- 
testinal fermentation.     Hence  the  significance  of  hereditarv 


lOO  HENRY     BAIRD     FAVILL 

mucous  membrane  defect,  at  this  point  more  potent  for 
harm  than  at  all  other  points  in  the  body. 

If  this  barrier  to  improper  food  is  destroyed  the  system 
becomes  intoxicated.  This  is  no  speculation,  it  is  a  com- 
mon experience  and  the  bearing  of  these  facts  upon  the 
constitution  of  the  blood  is  vital. 

The  relation  of  diet  to  this  question  differs  somewhat 
from  the  foregoing  adjustments.  In  so  far  as  morbid  action 
depends  upon  intestinal  indigestion  and  its  results,  the 
dietetic  treatment  is  addressed  to  that  condition.  If,  how- 
ever, the  primary  digestive  act  is  complete  and  the  second- 
ary processes  essentially  at  fault,  the  effort  to  correct  by 
diet  becomes  a  plan  to  get  around  the  difficulty  rather  than 
to  establish  complete  restoration.  Such  are  the  features 
of  the  procedure  adopted  in  the  diet  of  the  gouty.  The 
very  initial  position  which  we  assume  with  regard  to  them 
is  a  confession  of  partial  defeat.  We  declare,  "There  are 
kinds  and  degrees  of  feeding  in  which  you  may  never  in- 
dulge, hence  your  disability  we  respect  by  carefully  avoid- 
ing the  issue."  Efficient  and  beneficent  though  these  meth- 
ods be,  they  may  not  be  said  to  be  other  than  broadly 
palliative.  It  is  here,  particularly,  that  we  find  occasion  to 
regard  most  seriously  the  historical  aspect  of  food  physi- 
ology. Hereditary  defect  in  the  food  transformations,  tak- 
ing place  between  the  mucous  membrane  of  the  intestine 
and  the  vessels  which  carry  the  perfected  blood  away  from 
the  liver  for  general  distribution,  is  the  most  important  fact 
in  the  pathology  of  so-called  constitutional  disease.  It  is 
manifest  in  the  earliest  infancy,  changes  and  marks  its 
form  in  a  multitude  of  ways  during  youth  and  adoles- 
cence, and  matures  into  more  or  less  typical  disability  in 
middle  life,  but  bearing  throughout  the  unmistakable 
stamp  which  identifies,  as  a  consistent  group,  the  protean 
aspects  of  disease  with  a  score  of  titles. 

The  third  class  of  conditions  whose  dependence  upon 
food   supply  is   intimate,   includes  the   cases  of  normally 


MEDIC  [NIC      AND      I'  [J  151,  I  C      HEAI^'IH  joi 

constituted  blood  for  which  there  is  not  adecjuate  demand; 
which  seems  perhaps  improbable.  However,  it  is  clear 
that  a  perfectly  normal  digestive  af;t,  afTordinj^  a  normal 
nutriment,  may  be  associated  for  a  time  at  least  with  abnor- 
mal rate  of  consumption  of  nutriment  which  will  disturb 
the  balance  of  nutrition. 

In  our  modern  methods  of  living  this  loss  of  relation 
is  of  frequent  occurrence.  Nutriment  is  furnished  to  the 
tissues  of  the  body  in  excess  of  their  demands.  Their 
capacity  to  take  up  is  limited  by  their  capacity  to  destroy. 
Oxidation,  the  process  by  which  all  chemical  transformation 
occurs,  by  which  food  fuel  becomes  transformed  into  waste 
ash,  is  measured  by  the  intrinsic  energy  of  the  cell. 

Excess  of  food  involves  incompleteness  of  combustion, 
so-called  sub-oxidation,  which  determines  absolutely  the 
loading  of  the  system  with  products  whose  usefulness  as 
food  is  gone,  and  whose  fitness  for  elimination  is  far  from 
perfect.  With  this  disproportion  between  food  and  expen- 
diture we  are  daily  confronted.  The  readjustment  is  rarely 
complicated.  The  principle  is  stable :  more  work,  less  food 
or  frequently  both. 

The  fourth  class  of  diseases  to  which  I  wish  to  allude 
are  those  in  which  elimination  of  effete  material  is  decreased. 
As  a  feature  of  the  foregoing  diseases  deficient  excretion  is 
usually  pronounced.  The  reason  in  these  events,  however, 
is  the  imperfection  of  the  processes  which  should  have  pre- 
pared the  waste  for  elimination,  and,  however  pernicious, 
not  to  be  charged  to  the  fault  of  the  eliminating  organs. 
Unquestionably,  however,  these  several  conditions  of  nutri- 
tive failure  are  the  efficient  cause  of  what  we  now  approach, 
organic  disease  of  the  principle  organs  of  elimination,  the 
kidneys,  and  at  this  point  we  encounter  limitations  most 
exacting. 

Kidneys  which  have  become  impaired  have  propor- 
tionately lost  their  power  of  selecting  waste  from  the  blood 
and  hence,  by  that  default,  burden  the  body  with  what  is 


I02  HENRY      BAIRD     FA  V  ILL 

most  deleterious.  The  degree  to  which  this  takes  place, 
of  course,  determines  the  gravity  of  the  situation,  but  it 
is  always  grave  for  two  reasons:  (i)  The  poisoning  of  the 
system  is  of  serious  character  and  leads  to  wide  degen- 
erations, and  (2)  the  continuance  of  a  demand  for  activity 
of  the  organ  beyond  its  capacity  rapidly  advances  its  own 
disorganization.  Hence,  in  this  condition  the  rule  is  invari- 
able. Reduce  the  demand  upon  the  organ  of  elimination 
to  as  nearly  its  performing  capacity  as  possible,  thereby 
striving  to  preclude  accumulations,  and  by  relief  of  over- 
strain to  maintain  the  highest  possible  integrity  of  structure. 
The  possibilities  in  this  attempt  are  almost  exclusively 
dietetic,  and  the  results  are,  even  in  desperate  matters, 
most  striking. 


MEDICI  NIC      AND      F' IJ  IM,  I  C     HEAf^TD  T03 


Delivered,  Chiraj.(()  Mcilical  Society,  January  iH,  iH()7. 
Printed,  Chicago  Medical  Recorder,  February,  1897. 

TREATMENT   OF   CHRONIC   NEPHRITIS 

NO  view  of  the  treatment  of  nephritis  ean  endure  that 
does  not  comprehensively  consider  the  etiology  of 
renal  degeneration.  I  use  the  term  degeneration 
advisedly,  because  in  only  a  very  small  proportion  of  cases 
is  an  inflammatory  process  truly  present.  Clinically  speak- 
ing, we  are  apparently  at  variance  with  the  pathologists, 
and  yet  I  assume  that  it  is  apparently  at  variance  rather 
than  actually.  Clinically,  nephritis  is  a  progressive  nutri- 
tive perversion,  leading  to  greater  or  less  necrosis,  ter- 
minating in  more  or  less  substitution  of  one  histological 
form  for  another.  There  can  be  no  doubt  that  in  the 
majority  of  instances  the  sequence  of  occurrence  is  this. 
Again,  when  we  come  to  consider  the  etiolog>%  we  have  to 
regard  the  causes  as  essentially  and  broadly  three;  namely, 
vascular,  septic,  and  toxic  causes.  Into  one  of  these  three 
categories  will  all  of  the  causative  factors  of  nephritis  ulti- 
mately fall.  The  importance  of  these  various  factors  arrange 
themselves  according  to  the  characteristics  of  the  case. 
Upon  these  various  etiological  factors  must  rest  the  prin- 
ciples of  therapeusis.  The  details  of  therapeusis,  however, 
must  have  a  somewhat  further  foundation  upon  which  to 
stand;  in'other  words,  we  must  have,  in  order  to  adequately 
select  and  administer  a  therapeutic  procedure,  to  some 
degree  or  other,  a  classification,  and  the  subject  of  classi- 
fication has  hitherto  been  most  unfortunately  complex. 
Clinically,  it  must  be  evident  to  those  who  have  heard  the 
papers  this  evening  and  who  are  disposed  to  agree  vdxh. 
them,  that  there  is  at  some  stage  of  the  proceedings  non- 
organic change,  in  which  nephritis  is  potentialh*  present. 
There  can  be  no  doubt  that  at  a  variable  period  before 
organic   change   can   be   detected  there  is  present  in  the 


104  HENRY     B  A  I  R  D     F  A  V  I  L  L 

functional  performing  capacity  of  the  cell  a  serious  defect. 
This  being  the  case,  it  becomes  a  most  interesting  problem 
how  remote  should  be  the  period  at  which  we  should  under- 
take to  treat  nephritis.  Practically  and  clearly  the  ques- 
tion must  be  answered- — as  early  as  the  diagnosis  can  be 
made;  and  hence  the  question  arises,  Can  the  diagnosis  be 
made  previous  to  anatomical  degeneration?  Upon  that 
point  I   cannot  stop  to  dwell. 

I  wish  to  refer  purely  to  the  cases  of  nephritis  of  the 
earliest  period  possible  for  diagnosis.  At  this  period  it  is 
possible  to  make  a  diagnosis  when  the  anatomical  destruc- 
tion of  kidney  is  very  slight,  and  it  is  at  this  period  that 
the  therapeutic  possibilities  of  the  treatment  of  nephritis 
lie.  Hence  the  treatment  has  a  distinctly  different  char- 
acter as  applying  to  the  early  and  to  the  late  forms  of 
nephritis,  and  a  clinical  distinction  is  safe,  and  as  a  working 
hypothesis  reasonably  correct,  which  distinguishes  between 
incipient  and  advanced  nephritis.  The  primary  indication 
upon  which  must  rest  the  treatment  of  nephritis  is  to  present 
to  the  kidney  for  excretion  such  products  of  food  metabolism 
and  tissue  change,  in  other  words,  such  waste  products,  as 
are  fit  for  elimination  and  in  no  larger  quantity  than  is 
within  the  capacity  of  the  kidney  to  excrete;  and  all  meas- 
ures, medicinal,  hygienic,  and  others,  which  are  of  any  value 
in  the  treatment  of  nephritis,  contribute  to  this  end.  A 
moment's  consideration  of  this  proposition  will  show  that 
if  correct,  the  treatment  of  nephritis  is  essentially  hygienic, 
and  amongst  other  hygienic  possibilities  most  noticeable 
is  the  dietetic.  It  would  be  interesting  if  it  were  possible 
to  dip  into  the  ultimate  physiology  of  food  stuffs.  It  is 
hardly  the  thing  to  do,  and  yet  one  hesitates  to  advance 
statements  more  or  less  dogmatically  upon  so  profound  a 
subject.  The  fact,  however,  briefly  stated,  is  this:  The 
quality  of  the  excretions  depends  upon  the  perfection  of 
bodily  combustion.  Excluding  now  external  intoxications 
and  various  other  things  which  I  do  not  wish  to  touch,  the 


Mi;  I)  I  CI  NIC      AND      PUBLIC      HEALTH  105 

question  of  food  sUiffs  with  reference  to  excretory  principles 
is  essentially  the  fincslion  of  the  perfection  of  oxidation, 
and  if  this  is  true  in  nei)hritis,  and  if  it  is  additionally  as 
true  in  gout,  both  of  which  I  believe,  the  selection  of  a 
definite  line  of  procedure  dietically  considered,  for  the  treat- 
ment of  nephritis,  becomes,  at  least  in  principle,  simple,  in 
detail  frequently  complex.  I  touch  u])on  this  for  the  pur- 
pose of,  if  ijossiblc,  harmonizing  to  a  degree  the  various 
apparently  diverse  recommendations  of  unquestioned  au- 
thorities as  to  dietetic  selection  in  nephritis.  You  will 
find  the  same  variation  in  recommendation  applying  to  the 
treatment  of  gout,  and  the  same  explanation  w^hich  will 
harmonize  one  will  harmonize  the  other,  and  I  believe  that 
they  are  essentially  in  harmony. 

The  question  is,  What  are  the  offending  food  stuffs  in 
either  condition?  There  is  no  question  amongst  observers, 
that  the  essential  offending  element  in  both  nephritis  and 
gout  is  defectively  oxidized  nitrogenous  food.  Yet  we  find 
one  class  of  observers  recommending  nitrogenous  food, 
and  another  class  of  observers  absolutely  prohibiting  nitrog- 
enous food.  Are  they  opposed  or  are  they  in  harmony? 
I  believe  that  they  are  in  harmony  in  principle;  that  is  to 
say,  I  believe  that  they  approach  the  subject  from  opposite 
sides  of  a  common  centre.  Why  is  nitrogenous  food  not 
oxidized?  Because  in  a  mixed  diet  it  is  the  most  difficult 
of  oxidation,  and  hence  the  oxidizing  possibilities  are,  as  a 
rule,  absorbed  by  the  more  easily  oxidizable  food  w4th  the 
result  of  leaving  a  residuum  of  unoxidized  nitrogenous 
food,  the  so-called  suboxidation  product.  On  the  other 
hand,  the  oxidization  of  starches  and  sugars  as  opposed  to 
nitrogenous  food  is  easy,  quick.  The  theory  of  the  thera- 
peutists who  withdraw  the  starches  and  sugars  in  the  treat- 
ment of  nephritis  and  gout  rests  in  a  measure  upon  an 
endeavor  to  withdraw  the  easily-  oxidizable  food,  thereby 
concentrating  all  oxidizing  power  upon  the  more  resistant, 
and    thereby    saving    digestion    in    many    other    respects. 


Io6  HENRY      BAIRD     FAVILL 

Conversely  the  nitrogenous  food  is  withdrawn  to  prevent  the 
accumulation  of  suboxidized  nitrogen  by  withdrawing  the 
source  of  supply.  It  is  not  a  difference  in  principle,  it  is 
a  difference  in  judgment  as  to  the  best  way  to  accomplish 
the  same  thing.  I  discuss  this  for  the  purpose  of  showing 
that  I  do  not  ignore  the  opinions  of  the  vast  class  of  good 
observers  who  do  not  think  dietetically  as  I  do  upon  this 
subject.  Personally,  I  consider  that  the  treatment  of 
nephritis  should  be  largely  a  dietary,  in  which  the  nitrog- 
enous food  is  withheld;  in  which  the  meat  and  other  essen- 
tial albumins,  proteids,  are  withheld,  with  the  exception 
of  the  proteids  contained  in  milk.  Clinical  experience,  I 
think,  bears  this  out,  and  the  question  to  what  degree  the 
diet  should  be  confined  to  milk  turns  largely  upon  the  ques- 
tion, what  is  the  essential  stage  of  proceeding;  in  other 
words,  what  is  the  functional  metabolic  capacity  of  the 
system  with  reference  to  other  foods?  Hence  the  treat- 
ment of  nephritis,  theoretically  and  typically,  I  would  say, 
should  be  the  treatment  by  a  milk  diet,  which  is  imprac- 
ticable, as  a  rule,  exclusively.  The  question  arises  how  far 
beyond  a  milk  diet  one  is  warranted  in  going.  And  the 
reply  should  be,  as  far  as  he  can  convince  himself  that  the 
system  will  properly  transform  other  foods,  completely  ox- 
idizing them  and  completely  excreting  them.  The  basis  of 
the  measure  which  we  have  of  the  oxidizing  power  is  the 
urea,  and  it  is  upon  the  rise  and  fall  of  variations  in  urea 
that  I  would  lay  the  greatest  stress  in  the  current  estimation 
of  the  systemic  doings  of  the  patient. 

Medicinally,  as  bearing  upon  this  question,  there  are 
only  one  or  two  suggestions  which  I  care  to  make,  because 
with  all  the  raft  of  therapeutic  measures  that  have  been 
employed  the  ones  which  are  good  are  few.  I  consider 
that  the  administration  of  iron  in  any  form  that  you  choose 
which  is  well  managed,  is  an  efficient  means  of  treatment, 
and  this  in  any  stage  of  the  disease  in  which  there  is  an 
essential   anemia.     The  reason  why,   probably,   iron  is  of 


MEDICINE      AND      P  U  H  L  I  C      IIFCy\r.T'Ff  107 

such  value  is  because  it  adds  to  the  oxidizing  machinery 
of  the  body,  because  it  adds  the  element  which  helps  the 
distribution  of  oxygen.  In  addition  to  iron,  I  consider  the 
administration  of  small  quantities  of  mercury  and  especi- 
ally of  calomel,  given  for  a  more  or  less  long  period,  to  be 
of  the  greatest  value  in  the  treatment  of  nephritis.  I 
believe  that  the  influence  of  calomel  upon  the  food  metab- 
olism and  upon  the  tissue  waste  and  destruction,  as  influ- 
enced by  the  liver,  is  distinctly  possible  by  the  long-contin- 
ued minute  administration  of  calomel.  Much  will  depend 
upon  the  individual,  but  as  large  a  dose  as  can  be  admin- 
istered persistently  without  affecting  the  bowels  should  be 
given,  and  this  on  an  average  will  range  from  one-twentieth 
of  a  grain  three  times  a  day  to  one-quarter  of  a  grain  three 
times  a  day,  to  be  continued  for  periods  of  a  month,  two 
months,  or  six  months,  as  the  case  may  be.  It  is  distinct- 
ly alterative  and  affects  the  metabolism  occurring  in  the 
liver.  Upon  these  two  drugs  I  would  rest  the  majority 
of  my  medicinal  therapeutics,  and  I  would  hesitate  to  go 
outside  of  it  in  discussing  other  things,  because  there  is 
no  limit. 

The  treatment  of  the  later  stages  of  nephritis  in  the 
larger  proportion  of  cases  is  the  treatment  of  the  complica- 
tions, or  the  coordinate  factors  of  disease  rather  than  the 
essential  nephritis.  The  treatment  of  the  complications  of 
nephritis  should  be  determined  as  they  arise,  in  the  majority 
of  cases,  and  should  assume  the  more  prominent  position. 


loS  HENRY      BAIRD      FAVILL 


Delivered  to  Alumni  of  Rush  Medical  College,  June,  1897. 
Printed,  Intercollegiate  Medical  Journal,  July,  1897. 

TOXIC   CORRELATION 

IN  regard  to  this  somewhat  startHng  title  I  wish  to 
explain  that  my  idea  is  to  suggest  the  fact,  that  there 
exist  in  our  clinical  experience  many  conditions  and 
combinations  of  conditions,  whose  origin  and  sequence 
bear  to  each  other  very  close  relation,  and  that  not  in  hap- 
hazard ways  but  in  ways  most  methodical. 

We  are  now  in  the  era  of  observation  of  toxic  phe- 
nomena, and  see  with  a  distinctness  heretofore  impossible 
much  of  the  truth  which  unlocks  obscure  situations. 

It  is  noteworthy  that  the  legitimate  fruit  of  the  most 
advanced  research  is  a  well-demonstrated  humoral  pathology, 
the  limits  of  which  one  dare  not  at  this  time  suggest. 

After  all  the  satisfactory  light  shed  by  cellular  path- 
ology, the  query  was  bound  to  come,  Why  has  a  cell  a 
pathology?  The  answer  has  come  provisionally  and  is 
furnished  by  chemists  and  biologists  as  follows:  The  per- 
verted cell  has  three  main  sources  of  its  degeneracy,  (a)  Its 
nutritive  supply  corresponding  to  environment,  (b)  its 
innervation,  constituting  its  functional  experience,  and 
(c)  its  tropic  control;  all  evolved  under  the  potential  of 
its  heredity. 

Therefore  when  we  regard  morbid  states  as  the  aggre- 
gate reaction  of  the  molecular  body  subject  to  those  in- 
fluences, need  we  be  surprised  that  the  simple  pathologic 
conditions  take  multiple  forms,  or  that  various  unlike 
manifestations  may  trace  a  common  origin? 

I  wish  to  confine  my  comments  to  conditions  which  are 
explained  by  toxic  materials  in  the  circulatory  blood,  and 
to  define  toxic  in  such  terms  as  to  imply  material  which 
is  noxious,  either  in  kind  or  in  relative  amount. 

It  is  not  possible,  even  if  time  permitted,  to  define  the 


MEDICINE     AND      I'  U  H  M  C      H  I-:  A  L  T  If  iO(j 

nature  of  the  toxic  substances  to  which  one  so  frequently 
refers.  However,  every  rational  analysis,  every  analogy, 
lends  color  to  the  assiiinf)tion  that  the  blood  is  the  means 
of  distribution,  in  addition  to  its  normal  constituents,  of 
extraneous  or  accumulated  agents  which  are,  broadly 
speaking,  toxic. 

Most  obvious  of  these  circulatory  distributions  are  the 
systemic  poisonings  occurring  in  the  course  of  septic  disease. 
It  is  at  this  day  superfluous  to  argue  the  toxic  quality  of 
blood  so  impregnated.  The  destructive  effect  upon  tissue 
is  too  familiar  for  comment.  And  yet  these  are  but  the 
acute  and  exaggerated  prototypes  after  which  follow 
innumerable  less  pronounced  intoxications  whose  clinical 
manifestations  have  tmtil  recently  borne  the  names  of  in- 
dividual diseases. 

There  must  be  dissected  and  rearranged  all  of  the  com- 
plex subjects  included  under  various  asthmas  and  rheu- 
matisms, bronchitides  and  headaches,  dyspepsias  and  diar- 
rhoeas—  each  with  its  many  sides,  and  all  susceptible  of 
more  or  less  correlation. 

As  a  text  for  my  remarks  I  wish  to  state  simply  the  facts 
in  a  case  selected  from  many  of  similar  import,  because  of 
its  greater  variety  of  morbid  phenomena. 

A  young  woman  of  thirty  years  of  age,  whose  health 
had  never  been  excellent,  had  had  since  childhood  a  cough, 
in  character  loose,  accompanied  at  times  by  profuse  ex- 
pectoration. At  twent3^-five  years,  she  fell  into  so-called 
nervous  prostration  and  in  the  course  of  it  developed  what 
has  been  called  asthma,  which  was  for  a  time,  and  has  been 
at  periods  since,  very  obstinate. 

In  addition  to  this,  and  in  behavior  quite  different, 
she  has  periods  of  great  dyspnoea,  accompanied  by  cold 
extremities,  great  prostration,  and  always  associated  \\dth 
gas  in  the  stomach  or  bowels. 

About  the  period  of  the  development  of  the  asthma,  she 
began  to  have  what  was  regarded  as  rheumatism  of  knees 


no  HENRY     BAIRDFAVILL 

and  various  joints,  which  was  wont  to  recur  with  much 
irregularity. 

During  all  the  period  and  in  fact,  in  a  minor  degree, 
always  she  has  been  prone  to  looseness  of  the  bowels,  lat- 
terly amounting  at  times  to  diarrhoea,  of  weeks'  duration. 

During  the  course  of  the  various  phases,  she  is  liable  to 
become  much  reduced,  and  to  be  under  the  general  sus- 
picion of  having  consumption. 

It  is  impossible  to  convey  an  adequate  idea  of  the 
elusive  and  surprising  character  of  this  case.  It  is,  how- 
ever, typical  of  conditions  which  we  encounter  often  less 
pronounced.  As  to  its  behavior,  a  word.  The  two  features, 
asthma  and  rheumatism,  are  very  sure  to  recur  in  given 
circumstances;  often  recur  together.  As  a  rule  their  ex- 
acerbation is  preceded  by  a  disturbance  of  the  digestive 
tract,  indicated  by  bloating  and  discomfort.  If  these  con- 
ditions continue,  diarrhoea  is  likely  to  recur,  and  as  it  con- 
tinues, the  distress  of  breathing,  and  the  pain  in  the  joints, 
often  are  mitigated. 

Frequently,  however,  these  two  conditions  seem  to  be, 
as  it  were,  reciprocal,  and  when  the  rheumatism  is  relieved 
medicinally,  the  asthma  promptly  sets  in.  The  special 
dyspnoea  above  referred  to  appears  quite  accidental,  is 
associated  with  gas  in  the  stomach  and  the  general  accom- 
paniments of  vasomotor  spasm.  In  fact  it  is  an  angio- 
spasm of  reflex  origin,  and  usually  transient.  As  I  have 
indicated,  the  periods  of  diarrhoea  and  profuse  bronchial 
secretion  are  liable  to  afford  comparative  immunity  from 
the  more  painful  features. 

Physical  examination  of  this  patient  is  essentially  nega- 
tive. Besides  a  moderate  aenemia  and  considerable  short- 
age of  urea,  the  clinical  investigations  yield  no  result. 

The  family  history  is  interesting,  and  it  was  great 
familiarity  with  family  traits  which  led  me  to  finally  asso- 
ciate the  case  as  I  do. 

The  mother  is  of  apparently  fine  physique,  but  really 


MEDICINE     AND      P  IJ  H  L  I  C      H  E  A  L  T  H  1 1 1 

of  delicate  consliUition,  with  marked  vascular  weakness,  as 
shown  by  extreme  varicose  veins,  (')n  the  whole  of  neurotic 
type,  well  controlled. 

The  father  is,  generally  speaking,  gouty,  though  his 
organic  lesion  up  to  this  date  is  confined  to  mild  degree  of 
interstitial  nephritis  and  a  marked  tendency  to  intestinal 
indigestion. 

Several  aunts  are  markedly  gouty,  one  having  distinct 
interstitial  nephritis;  one,  affections  of  the  nervous  system 
simulating  organic  bulbar  change;  another  has  clearly  a 
heart  participating  in  arterio-sclerosis ;  all  of  them  being 
ill,  or  comparatively  well,  according  to  the  rigidity  with 
which  they  adhere  to  the  regime  necessary  to  obviate  their 
auto-intoxications. 

All  of  these  facts  bear  in  my  opinion  more  or  less  directly 
upon  the  proposition  which  I  make  in  the  premises.  I 
consider  that  the  various  forms  of  disturbance  shown  by 
this  patient  are  due  to  a  common  cause,  and  that  cause 
a  toxic  agent  developed  in  the  course  of  digestion. 

Digestion  in  this  sense  is  very  broad,  and  must  cover 
not  only  the  processes  of  gastric  and  intestinal  digestion, 
but  the  secondary  chemical  changes  which  take  place  from 
the  time  of  absorption  by  the  intestinal  mucosa  until  dis- 
charged into  the  hepatic  veins. 

To  maintain  this  proposition  does  not  involve  the 
assumption  or  demonstration  of  facts.  It  does,  however, 
involve  analysis  and  comparison  of  clinical  experience,  rather 
broadly  interpreted  to  be  satisfied: 

1.  That  asthmas  or  rheumatism  of  the  type  in  ques- 
tion may  be  the  result  of  the  products  of  vitiated  digestion. 

2.  That  these  two  morbid  phenomena  may  be  the  re- 
sult of  the  same  poison. 

3.  That  the  bronchitis  and  diarrhoea  bear  an  essential 
relation  to  the  digestive  vice. 

For  a  great  while  it  has  been  customary-  to  deal  \\-ith 
asthma  as  a  secondary  phenomena  and  to  regard  it  on  the 


112  HENRY     BAIRD     FAVILL 

whole  as  symptomatic.  Most  of  the  contention  upon  the 
point  has  been  to  class  it  as  a  reflex  nervous  reaction;  and 
the  primaty  cause  has  been  habitually  sought  in  distant 
local  irritation.  Though  not  disputing  the  possibility^  of 
such  an  asthma,  I  am  strongly  of  the  opinion  that  the 
morbid  influence  is  exerted  very  frequently  through  the 
blood  stream,  bringing  to  the  susceptible  organ  its  intoxi- 
cant, from  which  arises  the  distinctive  spasmodic  response. 
This,  to  be  sure,  might  be  reflex,  but  not  at  all  in  the  sense 
in  which  that  term  is  usually  employed. 

That  this  toxemia  is  of  digestive  origin  at  times,  is  hard 
to  demonstrate  but  of  great  probability.  In  support  of 
this  I  might  instance  records  in  my  possession  of  true  asth- 
ma in  children,  associated  with  flatulence  of  intestines  and 
evidence  of  hepatic-duodenal  failure,  disappearing  with 
correction  of  the  function  of  these  organs.  I  regard  such 
flatulence  as  not  causative,  but  simply  indicative  of  vices 
in  digestion  whose  result  is  to  load  the  blood  with  noxious 
material. 

Or  I  might  instance  the  alternating  asthma  and  chronic 
diarrhoea  not  seldom  found,  in  which  the  cessation  of 
diarrhoea  is  quite  likely  to  be  associated  with  hepatic 
stoppage,  and  prompt  recurrence  of  dyspnoea  to  be  relieved 
by  fully  opening  up  elimination. 

In  such  conditions  I  believe  the  checking  of  diarrhoea 
to  be  not  a  cause  of  asthma,  but  a  concomitant  indication 
of  some  vice  of  the  digestive  process  which  permits  intoxi- 
cation, leading  in  turn  to  asthma. 

Many  combinations  leading  to  the  same  conclusion 
might  be  presented  if  in  keeping  with  the  brevity  of  this 
discussion.  The  conclusion  is  almost  inevitable  that  asthma 
has  at  times  such  origin. 

Can  one  say  as  confidently  that  the  arthritis  to  which 
we  refer  as  rheumatism  may  be  of  similar  origin? 

Purposely  ignoring  the  obvious  relation  of  vicious  in- 
testinal  conditions  to   acute  rheumatism,   because  of  the 


M  l':i)  T  f"  I  N  TO      AND      F'  11  I?  I.  I  r:      HICAF.'fH  1/3 

complicating  question  of  ])ossi1)lc  infectiousness;  ancl  on 
the  other  side  avoiding  the  relation  of  gout  to  toxemia,  as 
involving  a  wider  genesis,  let  us  consider  the  freaks  of 
occasional  or  accidental  rheumatism. 

It  is  a  not  uncommon  experience  to  find  an  individual 
whose  liberty  to  use  alcoholics  is  limited  by  the  fact  that 
their  use  is  followed  by  distinct  rheumatic  pain.  This,  by 
no  means  invariably,  but  only  when  occasioning,  or  at  least 
associated  with,  marked  digestive  upset.  Usually  such  dis- 
ability does  not  follow  at  once. 

Thirty-six  or  forty-eight  hours  may  intervene.  Is  such 
an  occurrence  the  result  of  alcoholic  contact,  or  is  it  the  result 
of  secondary  toxins  formed  in  the  course  of  a  digestive 
lapse  first  induced  by  the  alcohol  ?  I  am  inclined  to  believe 
the  latter.  Again,  observation  of  chronic  rheumatism  of 
certain  types  leads  one  to  the  conclusion  that  the  general 
course  of  the  arthritis  is  quite  parallel  with  the  quality  of 
the  digestive  function.  That  this  may  be  complex  in  its 
explanation  is  likely,  but  it  serves  to  associate  the  offended 
joint  and  the  digestive  processes.  Much  might  be  cited 
to  further  this  view,  if  time  permitted. 

Assuming  the  relation  of  the  digestive  process  to  the 
symptoms,  are  we  justified  in  concluding  that  the  agency 
is  toxic  rather  than  reflex?  In  support  of  the  explanation 
by  toxemia,  let  me  but  mention  frequent  occurrence  of 
asthmatic  symptoms  in  the  form  of  uremic  dyspnoea, 
gouty  bronchitis,  aggravated  bronchial  irritation  from  so- 
called  "insufficient"  kidneys;  or,  again,  the  repeated  joint 
involvement  in  certain  forms  of  nephritis,  the  painful 
affections  of  tendon  and  fascia  incident  to  certain  plethoric 
states,  all  of  which  are  in  their  origin  strictly  toxic.  The 
fact  that  these  are  essentially  from  "retention"  toxemia, 
does  not  at  all  render  it  less  probable  that  a  direct  intoxi- 
cation may  be  operative. 

As  against  the  theor>^  of  reflex  irritation  lies  the  fact 
that  these  complications  do  not  follow  at  once  the  digestive 


114  HENRY      BAIRD      FAVILL 

disturbance  as  indicated  to  exist  by  other  signs,  but  after 
an  interval  of  many  hours,  or  days. 

Emphasizing  this,  the  case  under  discussion  furnishes  a 
typical  instance  of  true  reflex  spasm.  As  noted  above,  under 
certain  conditions  of  gastric  irritation,  she  has  distressing 
periods  of  dyspnoea,  with  general  shock,  following  immediate- 
ly and  subsiding  as  the  stomach  condition  is  corrected,  or 
being  relieved  by  such  an  antispasmodic  as  nitroglycerin. 

Of  the  nervous  reflex  origin  of  this  angio-spasm  there 
can  be  little  question,  and  its  behavior  is  in  marked  con- 
trast to  the  other  types  of  spasm. 

The  second  question,  as  to  the  identity  of  the  poisons 
which  produce  these  very  different  manifestations,  I  must 
be  permitted  to  beg. 

Knowing  next  to  nothing  of  the  physiological  chemistry 
after  absorption  has  commenced,  and  as  little  of  the  prod- 
ucts of  unsatisfactory  primary  digestion,  it  is  useless  to 
argue  the  point.  Two  statements  may  be  made:  i,  That 
it  is  not  difficult  to  believe  that  one  toxin  may  on  differ- 
ent tissues  exert  various  influence;  2,  that  the  constant 
association  of  clinical  forms  suggests  a  uniformity  of  cause, 
much  easier  to  ascribe  to  one  morbid  process  recurring, 
than  to  two  recurring  at  the  same  time. 

The  third  question  is  as  to  the  relationship  of  the  diar- 
rhoea and  bronchitis  to  the  pathologic  whole.  I  intention- 
ally associate  them,  because  it  strikes  me  that  their  relation 
to  the  process  is  much  the  same.  Considering  the  long 
duration  of  both,  and  the  fact  that  other  evidences  of  dis- 
turbed digestion  have  been,  off  and  on,  present  for  years, 
I  am  inclined  to  regard  them  as  eliminative  efforts. 

Therapeutic  effort  to  check  these  symptoms  invariably 
results,  when  directed  to  the  local  condition,  in  aggravation 
of  the  distressing  features  of  the  case,  the  asthma  or  rheu- 
matism. Whereas  correction  of  these  conditions  by  atten- 
tion to  primary  causes,  as  I  hold  them,  that  is  by  securing 
perfect  digestion,  affords  relief  to  the  entire  group. 


M  ED  I  C  I  N  I-:      AND      T  (J  1{  L  I  c;      HI.  A  I.  I  If  115 

The  diarrhcija,  hence;,  in  this  light,  must  be  considered 
rather  more  than  a  carrying  off  of  residual  matter.  It 
must  be  essentially  an  excretory  act.  A  question  of  vast 
interest  arises  at  this  juncture:  At  what  point  of  the  di- 
gestive sequence  lies  the  fault  which  permits  the  noxious 
impregnation  of  the  blood?  In  general  two  fields  exist. 
The  territory  occupied  by  the  digestion  up  to  its  complete 
solution  of  foods:  the  alimentary  field.  The  other  occu- 
pied by  the  processes  of  fitting  the  absorbed  food  for  cir- 
culation: the  portal  field. 

The  developments  of  untoward  character,  possible  in 
the  alimentary  canal  as  a  result  of  defective  digestive  proc- 
ess, are  many. 

Does  not  the  recognition  of  these  and  their  baneful 
influence  involve  the  interrogation  of  the  portal  field? 
Is  not  the  portal  field  our  natural  protection  when  in  a 
state  of  functional  integrity?  Whatever  the  alimentary 
attack,  if  effective,  does  it  not  imply  that  the  natural 
barrier  of  the  portal  field  is  inadequate,  either  through 
failure  or  primary  unfitness? 

What  should  be  included  in  the  portal  field  in  this  con- 
nection? The  mucous  membrane  of  the  intestine,  the  portal 
vessels,  and  the  liver  cells  employed  in  the  elaborating  process. 

I  do  not  wish  to  take  time  to  more  than  impress  the 
importance  of  the  intestinal  mucosa.  It  is  not  just  a  mem- 
brane. In  transit  through  it,  food  is  absolutely  altered  in 
its  fundamental  qualities.  It  is  par  excellence  the  organ  of 
secondary  digestion.  Its  integrity  is  vital.  What  may 
be  its  reciprocal  relations  with  the  liver,  we  do  not  know, 
but  in  this  limited  area  will  be  found  an  explanation  of 
much  pathology. 

By  these  steps  of  indirect  and  comparative  reasoning 
I  have  reached  the  conclusion  previously  stated  as  to  my 
patient,  and  have  reached  the  suspicion  at  least  that  the 
fundamental  pathology'  is  in  the  intestinal  mucosa.  Ver}" 
many  cases  less  complicated  bear  the  same  analysis.     If 


ii6  HENRY      BAIRD     FA  V  ILL 

the  reasoning  is  even  approximately  correct,  it  serves  to 
attract  attention  to  the  futiHty  of  approaching  clinical 
work  through  nomenclature.  Much  as  I  value  the  gift 
of  definition,  I  deplore  the  tendency  to  make  it  in  any 
degree  explanatory.  It  must  be  purely  descriptive,  or  it 
becomes  a  cloud. 

In  the  foregoing  comments  I  have  endeavored  to  show- 
how  the  familiar  pictures  of  disease  appear  to  me;  not  as 
entities,  but  as  phases  in  the  activity  of  a  common  cause; 
In  this  instance,  as  the  reaction  of  various  organs  to  a 
strictly  toxic  agent,  and  with  widely  differing  morphological 
characteristics  intimately  correlated. 


MEDICI  Ni;      AND      IMJ  lU.  I  C      H  i:  A  L  T  If  117 


Delivered  at  a  dinner  of  the  Rush  Medical  College,  March  17,  1898. 
Printed,  Journal  of  the  American  Medical  Association,  April  9,  1898, 

MODERN   METHODS   OF   MEDICAL 
INSTRUCTION 

MY  interest  in  this  matter  is  not  greater  than  my 
marvel  at  the  enormous  advance  which  has  occurred 
within  the  short  space  of  years,  since  1880,  when  my 
medical  college  experience  commenced.  And  yet,  in  draw- 
ing the  comparison  which  so  forcibly  presents  itself,  I  must 
declare  that  it  is  not  to  the  discredit  of  the  early  day,  any 
more  than  that  day  was  a  rebuke  to  its  predecessor.  I 
believe  that  you  will  agree  with  me,  that  medical  education 
offered  to  students  at  that  day  was  as  nearly  abreast  of  the 
education  possible  for  them,  as  is  our  present  exhibition 
an  approach  to  the  present  possibility.  The  great  difference 
in  spirit  which  strikes  me  as  occurring  in  respect  to  medical 
education  in  general,  lies  in  the  attitude  of  the  public 
toward  the  profession,  or,  more  exactly,  of  the  State  toward 
the  medical  school.  In  this  the  change  is  ver>^  pronounced 
and  I  believe  the  advancement  is  very  clear.  It  is  on  the 
whole  a  matter  for  congratulation  both  to  the  schools  and 
the  profession  at  large,  that  society  has  seen  fit  to  demand 
that  we  require  of  the  medical  graduates  as  good  an  educa- 
tion as  we  offer.  That  this  change  has  been  instigated 
by  the  profession,  is  to  its  credit  and  does  not  qualify  the 
advantage  so  far  as  society  is  concerned.  That  the  means 
and  methods  to  this  end  have  been  at  times  unreasonable, 
inconvenient,  and  are  in  many  respects  meddlesome,  is  but 
a  passing  annoyance  as  compared  with  the  final  advantage, 
which  resides  in  the  fact,  that  while  the  public  is  properly 
protected  the  medical  schools  are  relieved  of  the  embar- 
rassment of  illegitimate  competition,  and  the  entire  process 
operates  as  a  measure  whereby  there  is  culled  the  unfit 
material. 


Ii8  HENRY      BAIRD     FAVILL 

When  we  come  to  consider  our  own  more  specific  interests 
as  educators  we  would  designate,  amongst  many  improve- 
ments, three  features  in  particular  which  claim  our  earnest 
consideration:  First,  the  laboratory;  second,  the  clinic; 
third,  the  recitation. 

Of  the  laboratory  too  much  can  not  be  said,  little  need 
be  said.  It  represents  the  utmost  development  of  the 
educational  idea.  To  have  incorporated  it  in  our  own 
affairs  to  the  extent  possibly  of  disproportionate  develop- 
ment credits  us  naturally  with  the  desire  to  be  entirely 
en  rapport  with  the  march  of  education  in  every  department. 

To  one  who  has  not  had  the  advantage  of  a  technical 
laboratory  training,  but  whose  interest  and  ambition  have 
led  him  to  the  acquirement  of  lame  and  half  satisfying 
methods  in  furtherance  of  his  desire  for  power,  the  idea  of 
laboratory  training  is  most  alluring.  Recognizing  this,  it 
suggests  to  me  qualifications  upon  which  I  wish  to  com- 
ment. The  laboratory  factor  is  liable  to  over-estimate  in 
two  directions:  i,  By  many  of  those  who  have  had  no 
laboratory  experience,  to  whom  the  revelations  of  the 
laboratory  assume  an  exaggerated  importance,  in  conse- 
quence of  the  mystery  which  surrounds  them;  and  on  the 
other  hand,  2,  by  those  whose  training  assures  their  posi- 
tion as  laboratory  experts  and  whose  occupation  is  of  that 
fortunate  stripe,  rare  in  medicine,  which  results  in  the 
demonstration  of  things.  These  men,  for  whom  I  have 
the  most  profound  respect,  naturally  regard  things  from  the 
laboratory  standpoint,  and  being  engrossed  in  it  and  trained 
to  the  primary  idea  of  truth  as  dependent  upon  demon- 
stration, are  not  quite  prepared  for  the  consideration  of 
subjects  which  have  as  yet  no  laboratory  point  of  view. 

Many  of  these  men  have  neither  the  inspiration  for, 
nor  the  tolerance  of,  the  field  of  speculative  medicine, 
within  which,  however,  occur  those  projected  lines,  along 
which  the  correlation  of  knowledge  for  its  practical  appli- 
cation must  occur. 


MEDICINE      AND      IM  :  HF,  I  C     H  E  A  I-  T  I  f  i  i<j 

These  two  rcscrv.'ilifjns  arc  of  minor  significance  except 
as  considered  in  the  Hght  of  curriculum,  and  serve  to  empha- 
size merely  the  indisputable  fact,  that  in  producing  a  bal- 
anced result,  medical  reasoners,  as  complementary  to  medi- 
cal investigators,  are  indispensable. 

Our  encomium  upon  the  laboratory  can  not  be  dimin- 
ished when  we  take  up  the  subject  of  the  clinic.  Here  there 
opens  before  us  the  hope  of  the  future.  Though  the  clinic 
has  always  existed,  it  is  to-day  in  form  and  in  spirit  quite 
different.  The  general  clinic  with  the  full  amphitheater, 
though  it  remains  in  the  form,  is  no  longer  the  arena  for 
the  demonstration  of  the  prowess,  or  for  the  personal  aggran- 
dizement, of  the  professor.  It  is  solely  for  the  purpose  of 
bringing  the  student  in  intimate  contact  with  conditions 
which  are  to  be  in  the  future  his  perplexities,  and  as  such  is 
capable  of  being  made  most  effective.  The  thing,  however, 
which  we  earnestly  crave  is  the  clinic  for  small  classes,  the 
smaller  the  better. 

The  first  advantage  claimed  for  this  is  that  the  student, 
being  permitted  to  examine  the  patients,  and  required  to 
make  a  diagnosis,  becomes  immensely  strengthened.  This 
is  in  a  measure  true,  though  I  believe  those  who  are  teaching 
clinically  would  agree  with  me  that  even  this  is  subor- 
dinate in  importance  to  the  fact  that  the  interchange  of 
thought  between  the  students  and  instructors,  in  immediate 
presence  of  the  subject,  is  usual,  to  a  degree  which  in  a  large 
class  is  impossible. 

I  approach  that  which  is  to  me  at  this  moment  of  some- 
what more  immediate  interest,  the  recitation. 

In  this  innovation,  we  find  the  most  signal  departure 
from  time  honored  method,  and  properly  administered  the 
most  promising  foundation  for  broad  education.  I  repeat, 
properly  administered,  because  I  am  positive  that  improp- 
erly administered  it  is  a  source  of  weakness.  I  stipulate, 
among  many  things,  four  which  are  primary  to  its  propriety. 

First,    that   the   classes   should   be   small,    because   we 


I20  HENRY      BAIRD     FAVILL 

accomplish  thereby,  in  this  compactness,  manageability, 
which  includes  the  greater  facility  in  determining  the  current 
acquisition  of  the  students.  And  second,  I  would  stipulate 
that  the  text  employed  be  various.  It  is  necessary  for 
obvious  reasons  to  have  a  uniform  text,  designated  as  a 
skeleton  upon  which  to  build,  but  I  am  emphatic  in  my 
declaration,  that  students  should  be  encouraged  to  seek 
the  information  preparatory  to  the  recitation,  from  every 
available  source,  and  that  this  exercise  should  be  the  meet- 
ing ground  upon  which  should  be  thrown  all  possible 
side  lights,  and  upon  which  should  be  harmonized,  as  far 
as  possible,  whatever  apparent  conflict  may  arise.  Thus 
we  lay  the  foundation  for  breadth  of  view. 

I  approach  the  third  requirement  with  hesitancy,  yet  I 
trust  even  by  my  colleagues  who  are  touched  by  this,  that 
I  shall  not  be  misunderstood.  I  believe  that  the  instruct- 
ors should  be  men  of  experience,  more  or  less  according  to 
the  subject  involved,  but  with  the  firm  conviction  that  the 
more  experienced  the  better.  I  am  sure  that  no  man  is 
so  capable  of  illuminating  the  obscure  path,  as  one  who  has 
been  lost  in  it. 

The  combination  of  intelligence  and  sympathy  which 
results  from  such  experience  is  invaluable  to  the  teacher. 
To  have  these  conditions  satisfied  ideally,  particularly  at 
the  outset  of  the  new  regime,  is  impossible.  To  build 
toward  them  is  imperative. 

To  this  end  I  suggest,  that  every  effort  be  made  to 
retain  in  the  service  of  the  institution  the  men  who  justify 
their  relation  to  it,  and  at  every  hand  to  so  dignify  their 
relation,  that  the  feeling  of  responsibility  shall  reinforce  the 
interest  which  may  flag  under  neglect. 

Fourth,  and  most  important,  comes  the  question  as  to 
the  relation  of  the  instructor  to  his  class.  Shall  he  be  a 
critic  whose  function  begins  and  ends  with  an  inquisition  as 
to  the  presence  and  industry  of  his  students  as  evidenced  by 
their  ability  to  recite,  which  function  I  would  not  underrate. 


M  I-:  D  I  C  I  N  !•:      AND      I'  ('  I',  L  I  C      IT  K  A  \.'V  ]l  1 2  i 

or  shall  he  be,  in   addition,  an  expounder  of  the  subject? 

That  the  latter  should  be,  admits  of  no  question. 

In  the  first  place,  because  medical  literature  is  unfor- 
tunately obscure  and  needs  intelligent  presentation.  In 
the  second  place,  medical  information  is  shifting  and  needs 
a  current  commentator  for  the  correction  of  the  miscon- 
ceptions of  the  past.  These  facts  being  beyond  dispute, 
the  question  simply  remains,  shall  this  important  work  be 
done  by  the  instructors  or  by  the  professor  at  large,  if  I 
may  use  the  term? 

Assuming  the  competency  of  the  instructor,  I  unhesi- 
tatingly select  him  for  the  function  for  two  reasons :  First, 
because  with  the  assumed  limited  class  one  secures  the 
psychologic  advantage  of  man  to  man  contact.  Second, 
because  the  essence  of  instructive  analysis  is  interrogation, 
which  implies  a  slowness  of  procedure,  and  a  quality  of 
relationship,  which  is  possible  only  in  the  class  room. 

It  might  be  queried  in  the  light  of  all  this  disposition 
of  labor  into  the  departments  of  subordinate  instructors, 
What  becomes  of  the  chief  faculty?  Are  they,  in  the  new 
adjustment,  mere  figure-heads?  I  confess  that  in  the 
extravagance  of  expression,  which  one  sometimes  hears  in 
discussion  of  the  new  regime,  it  might  so  appear.  To  me 
the  assumption  of  higher  achievement  through  the  working 
out  of  the  processes  just  discussed,  implies  a  field  of  useful- 
ness for  the  heads  of  the  departments  enormously  elevated 
and  dignified.  It  is  true  that  much  of  the  detail  of  their 
labor  is  cut  off.  It  is  true  that  much  of  the  prominence 
of  a  certain  kind  is  removed,  but  I  call  your  attention  to 
these  facts: 

In  medicine,  as  in  no  other  field  of  research,  there  is 
at  present  no  such  thing  as  fixed  authorit3^  The  dictum 
of  no  man  is  better  than  another's,  except  in  so  far  as  the 
depth  of  his  research  or  breadth  of  his  experience  and  the 
integrity  of  his  reasoning  process,  justify  it.  The  profes- 
sion has  not  to  deal  with  an  accumulated  mass  of  settled 


122  HENRY      BAIRD      FAVILL 

fact.  It  has  to  deal  with  an  enormous  reservoir  of  knowl- 
edge, into  which  flow  streams  of  more  or  less  disconnected 
observation.  But  for  every  drop  of  fixed  knowledge  there 
is  a  flood  of  interpretation,  and  upon  the  selection  of  the 
instrument  of  interpretation  will  rest  the  value  of  the  store 
which  the  student  may  acquire. 

Is  the  student  about  to  be  graduated  capable  of  being 
his  own  interpreter?  Is  he  sufficiently  in  possession  of  the 
facts,  and  has  he  the  perspective  to  enable  him  to  wisely 
select  the  theory  and  adopt  the  practice  under  such  condi- 
tions? Assuredly,  most  assuredly,  not.  Here,  then,  lies  the 
highest  prerogative  of  the  department  head. 

To  him  let  it  fall  to  summarize  knowledge,  to  analyze 
experience,  to  harmonize  conflict.  And  in  so  far  as  he  is 
fortunately  possessed  of  personality,  to  so  impress  himself 
and  his  wisdom  upon  the  students  that  he  utter  for  their 
provisional  guidance  a  working  hypothesis,  as  indispensable 
here  as  elsewhere,  which  shall  bear  the  stamp  of  the  organic 
body,  which  launches  its  graduates. 


M  K  I)  I  C  I  N  E     AND      IM;  H  \.  I  C      II  K  A  I,  F  If  i  23 

Printed,  'I'lic  Mrdiral  News,  Marcli  19,  1H98. 

TREATMENT   OF   ARTERIOSCLEROSIS 

IN  a  text  book  discussion  of  arteriosclerosis  there  is 
usually  expressed  a  certain  hopelessness  in  regard  to 
therapeutic  measures,  which,  I  am  frank  to  say,  is  not 
shared  by  the  author  of  this  paper.  This  skeptical  attitude 
is,  however,  not  at  all  extraordinary  in  consideration  of  the 
character  of  the  text-book  discussion  of  the  subject  which 
has  hitherto  prevailed.  When  the  consideration  of  arterio- 
sclerosis is  extended  past  the  aorta,  temporals,  radials, 
and  larger  arterial  trunks  in  general,  there  may  be  some 
hope  of  incorporating  it  in  a  logical  relation  to  disease  proc- 
esses the  therapeutics  of  which  are  tangible.  As  well  might 
one  dispose  of  the  complications  of  a  water  system  which 
tends  to  occlusion,  by  discussing  the  scale  in  the  mains; 
very  pertinent,  it  is  true,  as  to  accidental  bursting,  but 
utterly  worthless  in  an  analysis  of  the  dynamic  relations 
of  the  process. 

The  portrayal  of  the  ravages  of  arteriosclerosis  in  the 
aorta  is  graphic.  Is  the  description  of  what  occurs  in  the 
finest  arterioles  equally  impressed?  And  yet,  not  until 
the  subject  is  approached  from  the  side  of  the  capillar}^  and 
the  fine  arterial  twig  is  the  remarkable  symptom-complex 
of  this  affection  even  vaguely  comprehensible.  Further- 
more, not  until  one  struggles  to  fathom  the  relation  between 
cell  perversion  and  its  nourishment,  or  between  vitiated 
pabulum  and  tissue  degeneration,  or  between  circulatory 
dynamics  and  innervation,  can  he  hope  to  establish  an 
etiology  upon  which  to  rear  therapeutics.  It  is  not  my 
privilege  to  dwell  upon  etiolog}^  nor  do  I  desire  to  more 
than  allude  to  classification.  All  treatment  must  find  its 
reason  in  consideration  of  three  general  factors: 

I.     The  cell  and  its  natural  endowment. 


124  HENRY     BAIRD     FAVILL 

2.  The  character  of  the  supply  from  which  the  tissue 
derives  its  support. 

3 .  The  controlHng  influence  which  determines  its  nutri- 
tion and  functional  activity. 

Great  was  the  day  of  cellular  pathology'.  Greater  is 
this  day  of  investigation  of  morbid-cell  physiology,  the 
natural  exponent  of  morbid  anatomy.  The  endowment  of 
the  cell  is  the  resultant  of  its  inheritance  and  its  adaptation 
to  environment,  cooperative  or  antagonistic,  as  the  case 
may  be ;  the  management  of  its  difficulties  must  involve  the 
just  estimate  of  these  factors.  That  the  cell  has  a  morbid 
physiology  long  before  there  is  demonstrable  organic  change, 
admits  of  no  question.  To  determine  the  elements  of  this 
malfeasance  is  the  task  of  the  future.  Inseparable  from 
this  problem  is  the  consideration  of  the  vital  experience  of 
tissue  as  determined  by  the  nutrient  current  to  which  it 
is  exposed.  Hence,  we  come  to  regard  as  a  determining 
influence  in  morbid  development  the  vitiated  blood  supply 
which  reaches  the  part.  Thus  does  cell  pathology  reach 
back  into  the  darkness  and  lead  forth,  for  its  own  eluci- 
dation, a  new  and  enlightened  humoral  pathology. 

To  deal  with  arteriocapillary  fibrosis  in  respect  to  inner- 
vation is  a  most  venturesome  undertaking.  Of  the  facts 
in  question  we  know  nearly  nothing.  Analogy,  however, 
and  clinical  observation  compel  the  conclusion  that  the 
relationship  is  pronounced;  on  the  one  hand  trophci 
influence,  and  on  the  other,  functional  control,  combine  to 
furnish  the  activities  which  finally  develop  the  defects 
resulting  from  the  malnutrition  above  suggested. 

The  treatment  of  arteriosclerosis,  or,  as  more  sugges- 
tively called  by  Gull,  arteriocapillary  fibrosis,  should  be 
regarded  from  various  standpoints.  Unquestionably,  the 
better  knowledge  of  the  process  which  the  future  has  in 
store  will  admit  of  great  advance  in  prophylaxis.  The 
process  once  established  demands  relief,  for  one  or  both 
of  two  reasons:     Either  because  of  general   disability,  or 


MEDICTNTC      AND      IMJ  H  F.  I  C      HEAF.Trr  125 

because  of  special  predominance  in  orj^ans  which  demand 
specific  consideration.  It  is  not  too  trite  to  repeat  that 
"a  man  is  as  old  as  his  arteries."  No  relative  estimate 
of  age  compares  with  this.  It  implies  that  arterial  degen- 
eration is  the  physiologic  index  of  decadence.  It  becomes 
a  pathologic  condition  when  it  anticipates  years,  or  what 
is  the  same  thing,  exceeds  the  reasonable  expectancy  of  a 
given  period.  Whatever  conditions  contribute  to  this 
maladjustment  and  the  possibilities  of  modifying  them, 
determine  treatment.  As  a  rule,  before  the  arterial  degen- 
eration affords  distinct  symptoms  there  is  evidence  of 
the  toxemia  that  is  behind  it.  The  character  of  the 
toxemia  varies.  It  is  the  result  of  poisons  ingested,  or 
infection,  or  auto-intoxication.  Of  the  first  two,  as  of 
plumbism  or  syphilis,  little  may  be  said;  their  therapeutics 
are  well  defined.  Of  the  third,  much  must  be  said,  inas- 
much as  it  includes  the  greater  number  of  all  cases.  The 
common  factor  in  the  various  types  appears  to  be  defective 
food  metabolism.  The  active  agency  inducing  this  defect 
varies.  We  find  it  in  the  overfed  and  in  the  underfed;  in 
the  inactive  and  in  the  over-active;  in  the  young,  middle- 
aged,  and  old.  In  its  earlier  stages  it  usually  is  associated 
with  good  digestion;  rarely  w^ith  dyspepsia.  It  is  a  post- 
digestive  development.  The  most  constant  factor  in  a 
series  of  cases  is  evidence  of  incomplete  disposal  of  nitrog- 
enized  materials. 

Chemically,  we  determine  this  by  the  defective  excre- 
tion of  urea.  This  means  lessened  manufacture  of  urea, 
or  faulty  separation  of  urea,  or  both.  Clinically,  we  detect 
the  condition  in  symptoms  of  nitrogenous  intoxication,  the 
so-called  uric-acid  manifestations.  It  is  by  these  that  our 
attention  is  primaril}^  attracted,  and  in  this  analysis  we  are 
enabled  to  early  demonstrate  arterial  change.  That  the 
true  toxin  is  uric  acid  is  doubtful.  That  the  poisonous 
agents  generated  in  this  way  are  several  is  highly  probable, 
but  philosophy  must  reach  far  ahead  of  our  full  knowledge 


126  HENRY      BAIRD     FAVILL 

and  outline  the  probable.  These  facts  are  not  asserted  as 
ultimate.  Unless  lightly  held  as  provisional  data  they  are 
likely  to  mislead.  They  do,  however,  furnish  the  clinical 
characteristics,  more  or  less  demonstrable,  which  serve  as 
a  basis  for  the  conclusion  that  the  essential  agency  in  this 
process  is  toxic,  and  for  the  most  part  autotoxic.  The 
treatment  at  this  stage  of  the  disease  is  essentially  hygienic. 
The  initial  proposition  is  how  to  adapt  the  individual  to 
his  environment.  In  general  the  elements  of  food  and 
physical  expenditure  are  at  fault.  The  important  require- 
ment is  that  food  should  be  adequately  introduced  and 
thoroughly  eliminated  when  no  longer  useful.  Decided 
failure  in  either  direction  is  destructive.  For  any  given 
individual,  "Is  his  food  adapted  to  his  work?"  should  be 
asked.  To  meet  this  query  what  do  you  demand?  That 
his  eliminating  organs  yield  the  proper  representation  of 
his  ingesta.  You  see  at  once  that  our  diagnostic  resources 
do  not  cover  such  elaborate  investigation,  and  yet  we  are 
not  without  resources. 

Clinically  we  have  well  recognized  evidences  of  toxemia 
by  which  to  measure  condition.  Believing  that  the  toxic 
agents  are  nitrogenous,  we  have  approximate  means  in  the 
estimation  of  urea  and  total  nitrogens  excreted  with  the 
urine.  Marked  departure  of  these  from  the  standard 
average  of  health  demands  explanation  and  correction.  So 
far  as  our  present  knowledge  goes,  it  points  to  defective 
combustion  as  the  efficient  cause  of  these  conditions.  At 
once  this  opens  the  most  complicated  questions  of  rela- 
tive combustibility  of  foods.  Into  this  we  can  not  enter. 
Sufficient  to  say,  that  quantity  is  quite  as  important  as 
quality. 

Given  a  good  digestion,  a  mixed  diet  may  be  right  or 
wrong,  according  to  the  quantity.  The  "rendering"  capac- 
ities of  the  body  have  definite  limitations,  and  react  accord- 
ingly. Clinically  we  encounter,  as  a  rule,  the  necessity  to 
diminish  the  nitrogenous  food,  or  to  change  the  form  of  its 


M  E  D  I  C  I  N  1<.      AND      I'  U  !U.  I  C      HEAL  T  11  127 

use.  Th.Ll  tlic;  stni^^lc  against  this  gradual  toxemia  may 
be  more  successfully  waged  by  attention  to  this  line  of 
procedure,  I  have  not  the  least  doubt.  Practically,  it 
amounts  to  the  gradual  adoption  of  a  mixed  milk  and  vege- 
table diet,  and  experience  fully  warrants  the  advocacy 
thereof.  It  is  remarkable  how  broadly  applicable  this 
simple  regulation  may  be.  Alone,  it  frequently  is  the  effi- 
cient means  of  correcting  the  phenomena  associated  with 
this  pathologic  state.  Of  these  may  be  mentioned  nervous- 
ness, sleeplessness,  shortness  of  breath,  faintness,  and  a 
number  of  allied  conditions,  dependent  for  their  causation 
upon  the  interplay  between  a  toxic  blood  and  pathologic- 
ally limited  capillary  distribution. 

It  is  true  that  the  arteriocapillary  limitation  may  be 
complex,  in  fact,  usually  is;  that  in  addition  to  structural 
encroachment  upon  the  blood  vessels,  there  is  usually 
muscular  over-action — spasm,  if  you  like  —  in  the  arteriole 
wall;  that  the  result  is  a  raising  of  general  blood  pressure 
by  the  participation  of  these  elements  in  various  degrees. 
Attention  should  be  directed  in  this  connection  to  the  dis- 
tinction between  arterial  pressure  and  arterial  rigidity. 
Associated  as  a  rule,  they  may  be  far  apart.  It  is  not  rare 
to  find  a  great  arteriosclerosis  with  arterial  rigidity  wide- 
spread, together  with  a  dangerously  low  blood  pressure. 
Of  the  complication  so  arising  we  shall  say  a  word  later. 
The  important  question  is:  To  what  extent  may  the  mis- 
chief of  heightened  arterial  pressure  be  avoided  by  attention 
to  this  nerve  reaction?  In  response,  I  adduce  as  the  next 
measure  of  treatment,  and  not  second  in  importance,  the 
adoption  of  an  even,  equable  life.  It  ought  not  to  require 
a  demonstration,  into  w^hich  we  can  not  now  enter,  to 
show  how  vital  is  the  principle  involved  in  this  question. 

All  of  the  life  influences  which  tend  to  exhaustion, 
incoordination,  and  perverted  nerve  control,  range  them- 
selves upon  the  one  hand;  all  of  the  forces  residing  in  de- 
liberate, coherent,  even  though  forceful  activities,  oppose 


128  HENRY     BAIRD     FAVILL 

themselves  —  to  the  end  that  it  Hes  within  reasonable  demon- 
stration that  the  poise  of  life  is  fully  as  determinative  of  its 
physical  destiny  as  are  the  factors  which  we  are  super- 
ficially in  the  habit  of  regarding  as  crucial.  When  we  come 
to  consider  more  specific  pathology,  and  search  for  indica- 
tions for  treatment  less  general,  we  find  that  the  occasion 
arises  in  connection  with  organic  change  in  many  vital 
organs.  Three  distinct  relations  between  special  organic 
change  and  general  sclerosis  are  possible,  and  frequently 
coexist.  The  special  change  in  an  organ  may  be  a  direct 
consequence  of  the  general  process;  or  it  may  be  a  part  of 
the  general  process,  that  is  to  say,  participating;  or  it  may 
be  in  a  measure  causative  of  the  general  process.  Without 
pausing  to  discuss  these  relationships,  it  is  possible  to  state 
that  the  clinical  phenomena  bear  a  constant  relation  to 
intra-arterial  pressure. 

Of  these  the  most  prominent  are  hypertrophy  of  the  heart 
and  polyuria;  the  heart  hypertrophy  occurring  as  a  truly 
conservative  process  in  response  to  enforced  labor;  the 
polyuria,  occurring  pari  passu  with  the  sclerosis  in  the  kid- 
neys, becomes  an  equally  compensatory  event.  In  so  far 
as  these  conditions  maintain  a  due  relation,  little  can  be 
done  to  alter  them.  It  is  at  the  point  of  failure  upon  one 
side  or  another  that  interference  becomes  necessary.  If, 
for  example,  the  heart  hypertrophy  begins  to  yield  to  its 
excess,  and  the  vis  a  tergo  is  withdrawn,  the  effect  upon 
circulatory  conditions  becomes  enormously  exaggerated. 
This  exaggeration  follows  the  fact  that  in  the  typical  con- 
dition resistance  in  the  capillary  area  has  been  met  by 
increased  force  of  the  heart,  with  the  result  of  creating  an 
intra-arterial  pressure  sufficient  to  maintain  the  circulation. 
Withdraw  even  slightly  the  heart  power,  and  you  have  left 
all  the  resistance  resulting  from  altered  caliber  minus  the 
blood  pressure;  hence,  ensues  stagnation  quite  out  of  pro- 
portion to  the  amount  of  heart  failure  involved. 

The  result  of  these  changes  upon  the  function  of  the 


M  K  T)  r  C  I  N  I<:      AND      P  U  H  I.  I  C      II  E  A  I.  T  IF  i  29 

kidney  is  in  all  cases  pronouncerl.  The  immediate  effect 
is  to  reduce  the  bulk  of  the  urine.  At  the  same  time,  the 
solid  excreta  of  the  urine  fall  short  and  there  supervenes 
a  more  or  less  intense  uremia.  Almost  the  same  description 
will  aj^ply  to  circumstances  in  which  the  blood  pressure 
has  been  suddenly  reduced  from  other  causes,  'i'he  chain 
of  serious  consequences  is  finally  chargeable  to  undue  dis- 
turbance of  a  blood  pressure  which  has  become  quasi-normal. 

It  is  important  to  estimate  these  phenomena  at  their 
true  value.  The  therapeutics  follow  absolutely  this  anal- 
ysis. The  indications  for  treatment  are  two:  To  restore 
the  balance  between  impelling  power  and  resistance,  and 
usually,  to  protect  the  interests  of  organs  which  have  grown 
dependent  upon  an  altered  pressure.  Therefore,  it  will 
not  do,  even  if  possible,  to  bring  down  the  peripheral 
resistance  to  the  capacity  of  the  heart;  the  pressure  must 
be  restored,  and  hence  the  invariable  rule:  When  the 
subject  with  arteriosclerosis  begins  to  fail  in  the  mainte- 
nance of  the  new  balance,  as  a  primary  move,  conserve  the 
energies  to  the  utmost  by  reducing  expenditure  in  every 
direction.  Hence,  put  the  patient  in  bed.  Regarding  the 
tendency  to  toxemic  complications  as  most  threatening, 
it  becomes  imperative  to  reduce  the  problem  of  nourishment 
to  its  simplest  terms;  that  is,  to  the  point  at  which  the  sys- 
tem most  nearl}^  protects  itself  from  toxic  accumulations. 
Hence,  reduce  the  diet,  perhaps  to  consist  simply  of  milk. 
Promote  the  interchange  of  fluids  in  the  tissues,  bringing 
fresh  materials  and  carrying  away  effete,  by  means  of  baths 
and  massage.  Secure  the  highest  possible  functional  per- 
fection in  the  organs  whose  efforts  control  food  and  tissue 
metabolism,  particularly  the  liver,  by  the  small  and  long 
continued  administration  of  calomel;  thereby  contributing 
in  the  highest  degree  to  the  final  and  indispensable  demand, 
namely,  that  elimination  be  not  allowed  to  flag. 

In  the  kidney  we  encounter  the  most  serious  obstacles. 
An  organ,  primarily  or  secondarily  cirrhotic,  dependent 
6 


I30  HENRY     BAIRD     FAVILL 

upon  a  high  blood  pressure,  finds  itself  choked  by  these 
conditions.  It  must  be  relieved.  To  this  end  the  follow- 
ing measures  ma}^  be  instituted:  In  the  absence  of  great 
edema  provide  sufficient  fiuid  ingesta.  Restore  the  equi- 
librium of  the  circulation,  to  accomplish  which  administer 
strychnin,  for  its  benefit  to  the  heart,  and  digitalis,  for  its 
effect  upon  the  peripheral  arterioles.  Recall  the  fact  that 
digitalis  may  not  be  indefinitely  used  in  these  conditions 
without  resulting  damage;  but  remember  also,  that  in  an 
emergency  like  this,  it  is  indispensable. 

In  thus  touching  here  and  there  a  salient  point  of  this 
subject,  I  have  striven  to  keep  in  mind  the  fact  that  the 
efficient  treatment  of  the  degeneration  in  question  lies  in 
prevention. 

To  know  the  signs  of  the  predegenerative  state,  and  fore- 
stall them,  is  the  highest  usefulness  of  the  physician.  Once 
the  disease  is  well  established,  the  treatment  becomes  a 
treatment  of  complications  and  emergencies.  Thoroughly 
investigated  in  the  beginning,  the  therapeutic  possibilities 
are  far  more  gratifying. 


MIODICINI-:      A  N  F>      I'  i;  H  L  I  C      HEALTH  131 


Delivered,  CliicriKo  Society  of  Iii1,crn;il  Medicine,  April  27,  1899. 
Printed,  Journal  of  the  American  Medical  Association,  February  11,  1900. 

TREATMENT   OF   ACUTE   RTTEUMATISM 

THE  task  of  discussing  the  treatment  of  acute  articular 
rheumatism,  as  a  cHmax  to  this  exhaustive  discourse, 
is  inevitably  rather  thankless.  Decided  convictions 
as  to  the  successful  and  satisfactory  therapy,  I  have  not. 
Too  many  times  has  experience  contradicted  and  reversed 
previous  conclusions  to  permit  me  to  hold  dogmatically  to 
lines  of  procedure  at  all  inflexible.  Too  thoroughly  ground  in 
upon  me  are  the  doubts  and  disappointments  of  clinicians, 
to  allow  me  to  harbor  the  hope  of  authoritative  routine. 

What  I  have  to  offer  is  a  tentative  and  provisional 
interpretation  of  accumulated  experience,  which  seeks  to 
harmonize  obvious  conflicts  in  the  line  of  advance  of 
investigations  in  this  field.  The  history  of  the  subject  is 
full  of  interest.  The  frequency  of  occurrence  and  ease  of 
diagnosis  have  made  this  an  inviting  field  for  therapeutic 
measures.  The  consequences  have,  as  usual  in  such  circum- 
stances, been  more  or  less  disastrous.  The  number  of  plans 
and  agents  which  have  traversed  the  scale  from  favor  to 
disfavor  must  create  the  impression  that  treatment  has  been 
in  the  past  unsatisfactory.  That  such  is  the  fact,  the  thera- 
peutic nihilism  of  many  close  observers  abundantly  evinces. 
The  subject,  however,  is  not  for  such  reasons  barren. 

Without  undertaking  to  deal  with  the  detail  of  develop- 
ment of  this  subject,  I  wish  to  refer  to  the  various  points 
of  view  heretofore  held,  and  to  comment  on  the  tendencies 
of  treatment  following  such  outlook. 

With  noticeable  uniformity  the  more  or  less  imperfect 
groupings  of  symptoms  which  have  been  called  rheumatism 
have  been  attributed  to  altered  conditions  of  the  blood. 
The  conception  of  constitutional  character  is  quite  likely 
most  natural;  in  view  of  the  clinic  behavior  of  the  disease, 


132  HENRY     BAIRD     FAVILL 

it  would  indeed  be  very  difficult  to  long  regard  it  as  local. 

Morbific  influence  generally  located  in  the  blood  has 
been  accepted  as  at  least  a  fixed  factor  in  etiology.  The 
genesis  of  the  morbid  material  will  afford  endless  discussion. 

Only  so  far  as  it  underlies  therapeutics  need  I  enter 
that  territory.  The  earlier  history  of  treatment  shows  at 
various  times  divers  theories  as  to  the  nature  of  the  poison. 
Removal,  neutralization,  or  antagonism  of  the  morbific 
substance  distinguished  the  serial  steps  in  the  evolution  of 
treatment. 

Almost  uniformly  before  about  i860,  the  measures  of 
treatment  were  depurative:  Bleeding,  catharsis,  diapho- 
resis, emesis,  blistering.  Each  of  these  measures  has  abun- 
dant testimony  to  show  its  value  at  some  point.  The  grand 
result,  however,  as  viewed  from  this  distance,  must  be  re- 
garded as  at  least  questionable.  On  the  whole,  I  believe 
patients  were  better  untreated. 

The  next  advance  in  practice  is  marked  by  the  utterance 
of  the  lactic  acid  theory,  whose  corollary  was  the  alkaline 
plan  of  neutralization.  Upon  this  territory  therapeutics 
rested  for  a  considerable  period,  and  with  distinct  advantage 
and  permanent  improvement  in  method.  It  must  be  said, 
however,  that  the  acid  theory  has  not  been  substantiated, 
and  that  the  general  improvement  in  results  must  have 
another  explanation  than  that  implied  at  its  adoption. 

Then  ensued  the  period  influenced  by  Trousseau,  as 
usual,  most  observant  and  sound.  His  dicta  are  to-day 
cardinal :  ' '  No  case  should  be  treated  upon  a  predetermined 
routine."  "Avoid  congestions  of  the  encephalon."  "Be- 
ware the  anemia  which  follows  overuse  of  alkalies." 

Then  followed  the  period  in  which  Flint  was  the  con- 
spicuous light.  Close  judicial  observations  of  the  natural 
history  of  the  process  without  treatment,  conducted  by 
him,  served  to  abruptly  correct  the  theories  of  specifics. 
His  conclusions  are  fundamental  as  a  basis  of  comparison 
of  various  medicinal  plans. 


MEDICINE      AND      IMIIU.  IC;      H  K  A  I.  I   H  133 

Soon  followed  the  introduction  of  the  salicyl  element  in 
various  forms.  In  tliis  was  great  promise,  and  its  early 
history  was  such  as  to  encourage  the  hope  for  a  specific. 
That  this  hope  has  not  been  fulfilled  does  not  belittle  its 
value  nor  gainsay  the  fact  that  it,  of  all  the  drugs  at  our 
command,  is  the  most  efificient. 

That  the  obviously  imperfect  compass  of  these  theories 
may  still  within  its  limits  have  been  sound,  we  can  not  dis- 
pute. The  scope  of  such  views  is  too  limited  to  harmonize 
with  advancing  know^lcdge,  and  the  deeper  levels  of  causa- 
tion must  be  explored.  The  more  intricate  reactions  of 
physiology  and  biology  will  of  necessity  be  invoked  to  clear 
up  this  obscurity.  We  are  not  materially  nearer  to  a 
determining  cause  than  our  predecessors,  but  the  lines 
upon  which  our  progress  will  occur  are  better  determined 
and  the  points  in  controversy  more  defined. 

Have  we  to  deal  with  a  local  or  general  condition  ?  Mere 
multiplicity  of  lesions  does  not  settle  that  point,  nor  do  the 
whimsical  shifts  of  site.  The  preceding  essays,  however, 
have  clearly  set  forth  the  reasons  for  regarding  it  as  consti- 
tutional. Next,  is  it  septic  or  toxic?  If  toxic,  is  it  from 
invaders,  or  is  it  autotoxic?  In  this  field  controversy  must 
occur,  and  the  issue  can  not  fail  to  be  momentous,  especi- 
ally as  bearing  on  treatment.  We  must  sharply  discrimi- 
nate between  true  sepsis,  the  manifestation  of  pathogenic 
germs  in  the  tissues,  and  intoxication  as  an  absorption  from 
septic  development  in  the  intestinal  tract,  or  other  external 
site.  And  again,  we  must  sharpty  discriminate  between 
toxins  from  such  infective  sources,  and  toxins  of  metabolic 
origin. 

The  territor}^  which  must  be  examined  to  clear  this 
obscurity  is  broad.  We  have  little  demonstrated  knowl- 
edge upon  which  to  found  a  patholog}\  Analog}'  and 
inferential  conclusions  are,  on  the  whole,  strong,  and  our 
views  of  the  process  are  not  seriously  discordant  '^■ith  the 
past. 


134  HENRY      BAIRD     FA  V  ILL 

A  comprehensive  view  of  this  subject  involves  various 
postulates.  To  begin  with,  rheumatism  is  not  of  necessity 
arthritis.  '  A  glance  at  clinic  manifestations  of  childhood 
makes  that  evident.  Endocarditis,  chorea,  and  arthritis 
are  the  trilogy  of  the  rheumatic  picture  in  youth,  and  in 
that  relative  order  of  frequency.  It  is  not  competent  for 
me  to  here  contend  for  this,  as  it  seems  to  me,  clear  asso- 
ciation of  clinic  conditions. 

Could  anything  more  strikingly  illustrate  the  com- 
plexity of  the  problem  of  treatment?  What  have  these  in 
common,  and  where  is  the  point  of  divergence  which  deter- 
mines their  various  aspects? 

Is  it  not  a  mistake  to  regard  them  as  sequential?  Is 
either  especially  the  lesion  of  rheumatism?  Are  they  not 
all  clear  expressions  of  the  rheumatic  state,  infection,  or 
intoxication,  the  determining  factor  of  whose  morphology 
has  not  been  made  apparent? 

It  is  difficult  to  separate  and  clearly  define  the  various 
rheumatisms.  Whereas  the  typic  examples  are  well  enough 
defined,  the  shadings  and  graduations,  especially  in  the 
joint  manifestations  of  the  adult,  are  by  no  means  simple 
of  distinction.  It  seems  to  me  it  must  be  recognized  that 
a  certain  kinship  exists  between  the  arthritis  of  acute  rheu- 
matism, and  the  various  forms  of  chronic  and  recurrent 
joint  and  muscle  morbidity,  whose  classification  will  range 
from  subacute  muscular  rheumatism  to  typic  gout.  What 
this  kinship  is  may  well  receive  our  attention. 

How  the  characteristics  common  to  the  class  become 
modified  to  present  acute  articular  rheumatism,  is  the  ques- 
tion for  whose  solution  is  awaiting  the  true  therapy  of 
rheumatism. 

One  need  not  cite  too  extensively  the  common  features. 
Let  us  but  consider  the  uniformity  with  which  the  group 
is  associated,  on  the  one  hand  with  gastro-intestinal  vice, 
and  on  the  other  with  hepatic  default.  That  there  is  a 
more  or  less  definite  association  of  type  with  each  of  these 


M  K  F)  I  C"  r  N  l<:      AND      I'  I !  I',  [,  F  C      IF  (-:  A  F.  T  If  135 

visceral  conditions,  I  believe,  hut  that  is  here  beside  the 
question.  Is  it  sound  to  recognize  the  association,  and  may 
we  consider  the  sequential,  if  not  the  causal,  relation  estab- 
lished ? 

My  belief  in  this  would  constitute  my  second  postulate. 
I  recognize  the  relation  as  one  of  intoxication,  either  derived 
from  the.  intestine,  by  absorption  of  noxious  products  there 
developed,  which  process  should  be  called  autotoxic,  or  an 
intoxication  engendered  in  the  process  of  defective  trans- 
formations of  food  after  absorption,  especially  in  conse- 
quence of  hepatic  failure,  which  I  would  distinguish  as 
metabolic.  Upon  this  broad  territory  we  find  arranged 
the  changeable  pictures  of  joint,  muscle,  and  nerve  mala- 
dies, and  from  this  foundation  we  may  erect  specific  struc- 
tures of  disease,  which  result  from  the  introduction  of  one 
or  many  new  etiologic  factors. 

It  is  forced  upon  us  that  the  behavior  of  acute  rheuma- 
tism is  like  that  of  the  other  infections.  All  new  light  seems 
to  emphasize  that  view.  Nevertheless,  the  underlying  con- 
ditions of  autogenetic  intoxication  must  be  recognized  as 
of  fully  coordinate  influence.  I  dwell  upon  this,  because 
I  consider  that  it  is  the  side  of  the  problem  to  which  the 
therapeutics  can  bring  some  measure  of  correction.  To  be 
sure,  the  same  relation  may  be  assumed  in  some  degree  as 
to  other  infections,  but  by  no  means  with  the  same  direct- 
ness. The  clinic  relationships  in  the  rheumatic  group  are 
striking.  Take,  for  example,  tonsillitis,  for  the  moment  not 
questioning  as  to  its  exact  type.  Assume,  if  you  like,  as 
is  argued,  that  it  is  the  gateway  of  infection  that  may  deter- 
mine rheumatism.  Is  it  not  always  associated  with  a  pro- 
nounced biliousness,  and  is  not  biliousness  a  pre-existing 
intoxication?  Though  difficult  to  demonstrate,  I  am  dis- 
posed to  think  that  the  line  between  tonsillitis  and  an 
attack  of  rheumatism  may  be  determined  by  the  relief  of 
the  biliousness,  hence  my  emphasis  of  the  underlying  toxic 
state. 


136  HENRY     BAIRD     FAVILL 

In  the  early  stage  of  acute  arthritis,  the  prime  con- 
sideration is  the  reHef  of  pain.  The  graphic  description 
given  in  the  earher  part  of  this  discussion  (see  Journal, 
pp.  304  et  seq.)  can  but  demonstrate  the  destructive  effect 
of  this  process  upon  the  nerve  centers.  The  logic  point 
of  therapeutics,  however,  is  elimination.  I  have  no  doubt 
as  to  the  influence  upon  duration  and  complications  of 
depurative  measures.  Fortunately,  the  efficiency  of  our 
most  valuable  drug  is  in  both  of  these  directions. 

The  salicyl  element,  particularly  in  the  salicylate  of 
soda,  is,  in  rheumatism,  par  excellence,  an  analgesic.  In 
many  conditions  besides  rheumatism  it  is  a  pronounced 
eliminant.  Is  not  its  superiority  over  other  analgesics  due 
to  this  fact?  I  can  not  accept  the  theory  that  it  acts  in 
rheumatism  as  an  antiseptic.  I  am  inclined  to  think  that 
its  especial  value,  over,  for  example,  the  coal-tar  group, 
lies  in  its  influence  upon  destructive  metabolism,  the 
promotion  of  which  must  underlie  elimination.  Thus  is 
grounded  my  belief  in  salicylate  of  soda  in  the  early  stages 
of  rheumatism,  given  in  profusion  while  necessary  to  relieve 
pain;  more  moderately  when  the  effect  is  directed  toward 
elimination;  but  given  to  its  effect,  almost  without  regard 
to  dosage,  though  for  brief  periods.  Its  heroic  pressure  for 
long  periods  has  properly  fallen  into  disfavor. 

What  can  be  considered  a  limit  as  to  amount  is  hard 
to  say.  One  to  three  drams,  however,  in  twenty-four 
hours,  is  perhaps  a  fair  statement.  This  limit  is  determined 
by  the  relief  of  pain.  Other  analgesics  will  occasionally 
answer.  I  have  seen  the  pain  of  acute  rheumatism  cut 
short  by  a  single  dose  of  antipyrin.  As  a  rule,  the  coal-tars 
are  a  disappointment,  and  not  safe  in  large  quantities. 
Exceptionally,  both  the  salicylates  and  coal-tar  products 
are  not  well  borne,  especially  by  reason  of  cerebral  mani- 
festations, which  are  disquieting.  Under  such  circum- 
stances pain  must  be  relieved,  and  if  necessary  by  opium 
in  some  form.     Pain,  however,  may  be  much  palliated  at 


MEDICI  NIC     AND      IMJ  15  [.  I  C     II  R  A  I.  T  II         r37 

times  by  local  attention;  warmth,  counter-irritation,  immo- 
bilization are,  singly  or  combined,  indicated. 

Whether  to  irritate  by  blister,  liniment,  or  cautery, 
will  depend  upon  the  type  of  the  case  in  hand,  though 
generally  speaking,  the  cautery  is  most  efficient.  It  is,  on 
the  whole,  not  often  that  such  measures  are  necessary. 
Warmth  to  the  parts  involved,  and  reasonable  attention  to 
the  general  warmth  of  the  patient,  must  be  regarded  as 
indispensable.  So  far  as  I  am  informed,  the  new  process 
of  extreme  dry  heat  is  not  of  value  in  acute  febrile  con- 
ditions. 

As  a  rule,  immobilization  of  a  joint,  even  in  the  acute 
stage,  will  afford  appreciable  relief.  Plaster  of  Paris  is 
our  best  agent,  because  of  its  permanence  and  cleanliness, 
though  not  at  all  times  practicable.  Being  not  a  familiar 
resort,  its  use  in  such  circumstances  is  rather  slow  of  adop- 
tion, but  its  value  is  undoubted. 

Much  of  the  acute  rheumatism  has  not  severe  pain,  and 
in  most  cases  it  is  relieved  within  a  few  days.  The  condi- 
tions then  become  asthenic  and  pursue  a  tedious  course, 
wherein  the  bodily  depression  is  gradually  augmented  by 
an  anemia  of  toxic  origin,  while  the  local  manifestations 
are  likely  to  be  complicated  by  more  or  less  trophic  change. 
From  this  point  the  treatment  is  full  of  perplexity.  The 
insidious  effects  of  the  specific  toxemia  become  indistin- 
guishable from  the  autotoxemia,  which  I  regard  as  more 
or  less  constant. 

The  low  fever,  the  grumbling  joints,  the  deteriorated 
blood  form  a  familiar  picture  to  which  are  added  various 
irregular  manifestations  of  toxemia,  as  urticaria,  er\'-thema, 
renal  complications,  etc.,  and  not  infrequent^  at  this  stage 
an  outbreak  of  the  disease  afresh,  in  the  heart.  WTiat  to 
do  as  these  phases  pass  along,  to  prevent  or  mitigate  the 
dangers  which  we  know  to  exist,  is  always  a  problem. 
Intestinal  foulness  is  a  constant  feature  of  this  stage ;  hepatic 
torpor  is  an  important  factor  in  determining  this  foulness. 


138  HENRY     BAIRD     FAVILL 

Elimination  is  the  watchword,  by  skin,  kidneys,  intestines, 
and  by  hver.  Not  only  must  no  avoidable  accumulation 
be  permitted,  but  the  activity  of  the  emunctories  must  be 
invited. 

It  is  during  this  period  of  intoxication  without  pain 
that  the  alkaline  treatment  becomes  most  useful.  Why, 
I  can  not  say.  Unquestionably,  it  promotes  final  excretion. 
To  what  extent  does  it  promote  the  processes  which  neces- 
sarily preceded  excretion?  The  value  of  alkalis  in  many 
toxemias,  even  those  strictly  of  metabolic  origin,  is  well 
known.  That  this  value  lies  in  the  neutralization  of  acid, 
is  open  to  doubt ;  that  its  influence  is  in  promoting  elimina- 
tion, can  not  be  made  clear.  But  there  is  no  doubt  of  its 
value,  given  boldly  in  many  conditions  of  the  later  stages 
of  the  disease.  It  is  possible  to  abuse  the  method.  Trous- 
seau pointed  out  the  objectionable  anemia  which  too  much 
alkali  induces.  The  use  of  alkalies  should  not  be  uninter- 
rupted, nor  should  the  current  blood  state  be  ignored. 
Along  this  line,  also,  the  phosphate  of  sodium  is  of  use. 
Given  in  dram  doses  in  plenty  of  hot  water,  its  customary 
influence  upon  the  liver,  and  the  general  improvement  in 
intestinal  conditions,  are  most  effective  in  certain  cases. 

Mercurials,  which  were  the  standby  of  our  forefathers, 
are  on  the  whole  not  satisfactory.  If  given,  however,  my 
experience  would  lead  me  to  prefer  occasional  pronounced 
effects,  rather  than  the  sustained  effect  which  I  seek  in 
other  conditions. 

Of  all  questions  involved  in  the  therapeutics  of  rheuma- 
tism, the  greatest  is:  Can  we  influence  by  treatment  the 
tendency  to  the  development  of  grave  complications,  par- 
ticularly in  the  endocardium?  My  personal  observation 
does  not  lead  me  to  a  conclusion  on  this  point.  My  hos- 
pital experience  does,  however,  lead  me  to  great  distrust 
of  the  conclusions  deduced  from  the  hospital  records,  com- 
monly cited  in  this  argument.  I  need  hardly  emphasize 
the  great  inaccuracy  of  such  data  in  general.     Hence,  the 


MED  I  CI  NIC      AND      IMM'.  I.IC      \\K\\,\i\  139 

statistic  presentation  of  the  case,  which  is  not  only  dis- 
cordant, but  presents  upon  each  side  variations  of  a  small 
percentage,  I  am  not  at  all  disposed  to  be  guided  by.  Able 
men  declare  that  the  heart  development  is  less  likely  under 
the  salicylates.  As  able  men  also  declare  the  alkalies  have 
the  same  protective  power. 

Logically,  if  the  rheumatic  poison,  no  matter  what  its 
source,  is  at  all  antagonized  by  either  of  these  plans,  the 
endocarditis  and  pericarditis,  which  are  not  complications, 
but  coordinate  developments  of  the  disease,  will  be  influ- 
enced by  either  in  proportion  to  its  efficacy.  Personally, 
I  believe: 

1.  That  the  selection  of  remedies  should  not  be  by 
routine,   but  according  to  the  type  presented. 

2.  That  the  cases  will  be  appropriate  for  one  or  the 
other  treatment. 

3.  That  the  cases  with  pain  are  best  started  upon  the 
salicyl  treatment. 

4.  That  most  cases  are  better,  after  the  subsidence  of 
pain,  upon  an  alkaline  treatment. 

5.  That  the  usual  plan,  recognizing  the  value  of  both 
salicin  and  alkali,  of  combining  them  in  treatment,  has 
the  disadvantage  of  exhausting  one's  resources,  as  neither 
should  be  continued  indefinitely. 

When  the  heart  complications  do  occur,  the  plan  of  pro- 
cedure is  not  usually  materially  modified.  The  indication 
is  for  quiet.  Bodily  quiet,  cardiac  sedatives,  vascular  re- 
laxation, constitute  our  indication. 

Morphia  and  aconite  are  the  best  and  safest  cardiac 
sedatives.  Veratrin  is  very  valuable,  but  very  potent. 
These,  when  exhibited,  usually  provide  all  the  vascular 
relaxation  necessary.  However,  at  times  more  is  needed. 
Carbonate  of  ammonium,  iodid  of  potassium,  nitroglycerin, 
are  all  of  great  service  in  reducing  blood  pressure,  and 
hence  their  favorable  effect  upon  the  circulation,  too  often 
regarded  as  heart  stimulation. 


I40  HENRY      BAIRD     FA  V  ILL 

The  tendency  occasionally  manifested  to  congestion 
of  the  encephalon  must  be  regarded.  Long  ago,  Trousseau 
argued  against  quinine  on  this  ground.  Later  it  has  come 
to  be  rather  accepted  that  the  salicylates  must  have  similar 
restriction.  General  principles  apply.  We  all  hesitate  to 
further  congest  a  smouldering  encephalon.  The  nerve 
manifestations  are  our  only  guide.  These  may  mislead, 
but  we  have  no  better. 

If  the  symptoms  be  interpreted  as  indicative  of  cerebral 
irritation,  the  salicylates  should  give  way  to  the  alkalies. 

A  mild  grade  of  nephritis  is  very  common  in  the  course 
of  rheumatism.  It  is  rare  that  it  is  significant,  in  its  recent 
development,  but  its  treatment  should  be,  if  possible, 
alkaline. 

Frequently  cutaneous  eruptions  come  and  go  in  the 
course  of  the  disease.  They  need  perhaps  no  treatment, 
but  the  effect  of  treatment  upon  them  ought  to  be  instruc- 
tive as  bearing  upon  the  coexisting  toxemia.  For  example, 
one  sees  occasionally  repeated  crops  of  hives.  It  is  not 
without  its  significance,  that  the  same  remedy  that  is  effi- 
cacious in  general  is  also  so  here. 

Pilocarpin  is  almost  a  specific  for  this  condition.  May 
it  not  be  that  this  stimulation  of  pancreas  has  a  more  than 
casual  importance  in  this  question?  lam  disposed  to  think 
it  is  another  item  of  value  in  the  determining  of  the  part 
played  by  intestinal  vices. 

Concerning  dietetics,  I  care  to  say  little.  When  one  has 
taken  into  consideration  the  peculiarities  of  the  intestinal 
and  hepatic  conditions  that  may  be  present,  and  has 
attempted  to  proceed  in  accordance  with  the  general  prop- 
osition that  infectious  processes  are  usually  overfed,  he  finds 
himself  reduced  to  a  milk  and  farinaceous  diet,  and,  I  believe, 
on  the  whole  more  safely  so.  That  more  elaborate  methods 
become  necessary  in  the  recuperation  is  hardly  for  me  to 
discuss. 

There  is  no  doubt  that  the  treatment  of  rheumatism  is 


M  K  T)  I  (•  I  N  I<:      AND      IMJ  H  F.  I  C:      H  E  A  f.  f  If  14  r 

to  only  a  very  limited  dej^ree  curative,  though  abundantly 
palliative.  The  average  duration  has  not  been  materially 
affeeted  by  any  so-called  plan. 

This  does  not  warrant  inactivity  in  the  premises.  Skill- 
ful use  of  the  means  at  hand  is  imperative.  It  is  incum- 
bent upon  one  to  know  their  various  relations,  and  then  to 
adopt  as  a  guiding  principle  Trousseau's  rule:  "No  case 
should  be  treated  by  predetermined  routine." 

Right  in  the  face  of  this  sage  advice,  and  while  accepting 
it  fully,  I  venture  to  outline  a  routine,  which  I  would  apply 
to  a  typic  case.  Inasmuch  as  one  may  never  see  a  typic 
case,  the  stultification  may  not  be  so  great. 

1.  Empty  the  bowels  thoroughly,  preferably  with  a 
sharp  mercurial. 

2.  Administer  salicylate  of  soda  to  its  full  analgesic 
effect;  if  it  is  not  well  borne  by  the  stomach,  its  equivalent, 
oil  of  wintergreen.  If  it  is  contra-indicated  by  cerebral  con- 
ditions, use  antipyrin,  or  the  coal-tar  preparation  best 
adapted.  If  these  are  contra-indicated,  by  condition  of  the 
heart  or  nervous  system,  use  opium.  At  all  events  control 
pain, 

3.  As  the  pain  is  controlled  by  such  means,  aided  by 
local  measures,  particularly  heat  and  immobilization,  gradu- 
ally draw  away  the  saHcylate  element  and  saturate  the  sys- 
tem with  alkali,  continued  until  the  active  process  seems 
controlled. 

4.  Finally,  while  giving  alkali,  or  after  it,  administer 
iron,  providing  the  conditions  of  bowels  and  liver  permit. 

5.  At  all  times,  and  incessantly,  strive  to  promote 
intestinal  hygiene,  by  mercurial,  cholagogue,  or  saline,  with 
the  conviction  that  upon  the  processes  here  represented  the 
disease,  its  duration,  and  complications  largely  depend. 

Impatience  with  the  tediousness  of  the  course,  leading 
to  ill-considered  and  premature  activit}'-,  must  be  avoided. 

The  most  discouraging  behavior  will  swing  around  into 
satisfactory   convalescence,    often   in    the   briefest   period. 


142  HENRY      BAIRD     FA  V  ILL 

One  may  well  question  whether  his  efforts  have,  to  any 
considerable  degree,  influenced  the  course.  When  one 
considers  the  relief  of  suffering  in  the  acute  stages;  the 
specific  measures  of  treatment  appropriate  to  the  heart 
conditions ;  and  finally,  if  he  shares  the  view  that  the  general 
toxemia  is  an  important  element,  and  more  or  less  amenable 
to  corrective  measures,  he  will,  I  think,  be  satisfied  that 
there  is  abundant  scope  for  his  most  discriminating  judg- 
ment. 


MED  in  NT-:      AND      TMJ  H  I.  f  f      H  K  A  [,  T  H  [43 


Delivered  as  the   Aiinu.il    Address  cin    Medicine   before   Ihe  Wisconsin 

State  Medical  Society. 
Printed,  Western  Clinical  Recorder,  July,  1899. 

THE   RATIONAL   DIAGNOSIS 

I  OFFER  no  apology  for  bringing  to  your  attention  an 
address  which  suggests  in  its  title  a  speculative  cast. 
In  this  day  of  clamorous  facts  and  urgent  needs  of 
practical  processes,  we  have  little  time  to  spare  for  theoretical 
disquisition.  We  may  be  fundamentally  scholastic,  but  the 
demand  of  to-day  is  that  we  utilize  our  knowledge.  In 
full  recognition  of  these  facts,  I  emphasize  the  proposition 
that  never  was  there  so  much  material  nor  scope  for  medical 
reasoning  as  at  this  moment. 

It  is  hardly  necessary  to  point  to  the  array  of  forces  which 
have  to  be  marshaled  to  effective  power.  Centuries  of 
clinical  experience,  descriptive  observation,  and  empiric 
procedure  have  poured  forth  their  contribution  to  the  cause 
of  humanity.  Hardly  a  score  of  years  have  sufficed  to  put 
this  mass  of  medical  knowledge  into  vibration,  whose  only 
end  must  be  readjustment  and  harmonizing  of  data.  Great 
as  is  the  marvel  of  the  new  era,  greater  is  the  marvel  in 
the  rapidity  and  eagerness  with  which  medical  minds  have 
grasped  the  truth  and  molded  themselves  to  its  teaching, 
though  it  be  subversive  of  every  preconception  and  destruc- 
tive of  accumulated  formulae. 

Nothing,  however,  is  lost;  every  fixed  relation,  every 
established  law,  all  the  contributions  of  our  predecessors, 
more  or  less  misinterpreted,  are  the  material  out  of  which 
to  rear  the  structure  of  scientific  medicine  under  the  illumi- 
nation of  modern  thought. 

No  other  field  offers  the  wealth  of  opportunity  here  to 
be  found.  No  period  in  its  history  compares,  in  its  fruit- 
fulness,  with  the  present. 

Like  all  revolutions,  the  activit}^  of  the  last  few  years 


144  HENRY     BAIRD     FA  V  ILL 

has  affected  the  whole  structure  of  medicine.  New  path- 
ologic knowledge  suggests  an  ultimate  physiology  whose 
intricate  reactions  constitute  the  presentation  of  morbid 
relations,  which  we  apprehend  and  arrange  into  form  and 
the  true  significance  of  which  we  may  grasp,  and  achieve 
thereby,  a  diagnosis. 

The  fundamental  relation  of  pathology  to  diagnosis  is 
well  established.  It  has  been  indispensable  to  the  sys- 
tematizing of  knowledge.  But  its  groundwork  is  after  all 
morbid  anatomy,  and  that  is  no  longer  a  final  step  in  the 
path  to  causation.  Morbid  physiology  underlies  morbid 
anatomy,  precedes  it,  determines  it,  and,  as  its  elements 
are  made  clear,  coordinates  divers  morphological  entities 
in  a  common  genesis.  In  the  contemplation  of  scientific 
medicine  these  propositions  are  granted  and  present  little 
difficulty.  It  is  to  the  greater  field  of  application  that  I 
direct  your  attention. 

It  is,  on  the  whole,  a  deeper  intellectual  task  to  bring 
into  harmonious  relation  the  dicta  of  science  and  the 
practice  of  physic  than  to  discover  the  wonders  of  the 
laboratory.  The  reasons  for  this  are  practically  to  be 
found  in  the  nomenclature  growing  out  of  it.  We  have 
dwelt  in  the  contemplation  of  organs  and  their  changes. 
We  have  designated  structural  alterations  by  specific 
terms  and  have  divided  and  subdivided  such  presentation 
to  their  finest  distinction.  Finally,  we  have  sought  the 
origin  of  these  changes  in  the  altered  condition  of  the 
elemental  unit,  the  cell,  and  have  raised  a  classification 
upon  the  strictly  true  and  logical  hypothesis  that  morbid 
anatomy  is  primarily  cellular.  More  than  this,  we  have 
too  much  allowed  ourselves  to  consider  disease  manifesta- 
tions as  single  and  capable  of  existing  in  local  relation, 
ignoring  the  complete  interaction  of  bodily  parts.  Hence, 
we  have  outlined  and  reasonably  classified  the  gross  and 
histologic  departures  from  the  normal,  to  which  we  apply 
the  names  which  we  call  diseases,  and  have,  up  to  that 
point,  utterly  failed  of  the  grounding  of  a  diagnosis. 


MKDTCINR      AND      I'  (    i'.  [,  1  C      lli;A[,'III  145 

All  of  this  well-worked  m.-ilcriai  demanfis  another  step. 
The  finer  our  elassifieation  the  j^rcater  the  need,  because  the 
more  immediate  the  application  of  a  reason  for  cell  per- 
version. Our  advance  can  no  longer  be  anatomic  —  we 
cannot  get  our  solution  from  the  study  of  structure,  however 
important  and  enlightening.  We  have  no  recourse  but  the 
study  of  Process,  and  out  of  that  we  must  derive  the  origin 
of  disease.  The  limitations  of  our  knowledge  will  cause 
us  to  fall  far  short  of  final  solution,  but  the  status  of  the 
work  is  established  in  this  newer  territory,  and  this  path 
it  must  traverse. 

Consider,  for  example,  the  general  aspect  of  infection. 
Surgically,  it  has  long  since  come  to  pass  that  disease 
pictures  are  regarded  as  elaborations  of  septic  possibilities, 
occurring  under  more  or  less  known  conditions.  The  site 
of  infection,  the  structural  peculiarities,  even  the  organ 
involved,  are  subordinate  to  the  type  of  the  infection,  as 
manifested  in  its  own  development.  Morphologically  iden- 
tical agents,  under  conditions  indistinguishable,  produce 
the  widest  divergence  of  results.  The  physiology  of  the 
micro-organism  is  the  standard  of  its  power,  and  the  results 
of  its  implantation  are  regarded  as  the  strife  of  biologic 
antagonists  affecting  the  w^hole  economy,  rather  than  as 
organic  disease  or  default  to  which  the  infective  agency 
is  incidental. 

In  medicine  this  simplicity  of  view  is  not  so  established. 
We  talk  of  tonsillitis,  of  diphtheria,  of  croup  and  otitis 
media,  of  cystitis  and  metritis,  of  pneumonia  and  menin- 
gitis, maintaining  all  the  time,  to  a  large  extent,  the  anatomic 
relation  instead  of  the  infective.  Reflect,  for  example,  up- 
on the  fact  that  much  of  the  tonsillitis,  otitis,  pulmonitis, 
phlebitis,  meningitis  is  due  to  pneumococcus  infection. 
Reflect  further  that  this  same  group  of  words,  which  are 
too  often  regarded  as  the  designations  of  disease,  are  used 
to  cover  a  series  of  morbid  conditions  caused  by  the 
streptococcus ;  that  the  clinical  designation  of  diphtheria  has 


146  •       HENRY      BAIRD     FA  V  ILL 

lost  its  value  because  experience  and  demonstrations  show 
that,-  except  in  exaggerated  cases,  the  clinical  diagnosis 
cannot  be  made,  and  a  series  of  similar-looking  cases  may 
be  infections  with  streptococcus,  pneumococcus,  grippe  or 
true  diphtheria. 

Similarly  the  important  territory  of  the  bladder  and 
uterus  is  subject  to  infection  whose  character  and  import- 
ance is  determinable  only  by  recognition  of  the  type.  Still 
we  talk  of  cystitis  and  metritis. 

Upon  the  basis  of  this  anatomic  diagnosis  lend  me  your 
aid  in  selecting  a  reliable  and  permanent  diagnosis  for  a 
patient  whom  I  now  have  who  had  in  sequence  tonsillitis, 
bronchitis,  meningitis,  pneumonia  (right),  crural  phlebitis, 
pneumonia  (left),  crural  phlebitis  of  the  opposite  side, 
pneumonia  again,  empyema,  abortion  —  all  but  the  last 
two  demonstrably  of  pneumococcus  origin.  Is  it  not  per- 
fectly clear  that  we  must  take  a  different  point  of  view, 
both  as  to  site  of  morbid  anatomy  and  as  to  the  significance 
of  symptoms?  Must  we  not  recognize  general  pneumo- 
coccus infection,  accidentally  located,  with  toxic  symptoms  ? 

So  with  otitis,  leading  to  meningitis,  enteritis  or  any 
of  its  so-called  complications.  We  can  neither  dispose  of 
such  conditions  by  anatomic  description  nor  at  all  grasp 
their  clinical  importance  and  behavior,  without  a  broader 
point  of  view.  Under  these  circumstances  the  use  of  the 
term  tonsillitis,  follicular  tonsillitis,  and  all  the  rest,  is  but 
a  provisional  measure  while  we  await  better  things,  but  it 
is  imperative  that  we  become  at  once  and  permanently 
dissatisfied  with  the  method,  and  see  clearly  the  way  out, 
which  is  in  distinguishing  by  some  means  the  characteristic 
feature;  adopting  the  habit  of  regarding  all  such  things  as 
infections  of  definite  type;  and  demanding  of  ourselves 
that  we  determine  the  infective  agent  before  we  lay  claim 
to  a  diagnosis,  and  in  the  event  of  incomplete  facilities  for 
such  diagnosis  that  we  admit  the  lapse  in  our  process, 
while  striving  to  identify  our  disease  by  all  positive  means. 


MEDICINE      AND      PUBLIC      III:AI.TH  147 

Ivcl  us  concede,  if  necessary,  thai  the  ultimate  diagnosis 
now  possible,  owing  to  the  technique  involved,  is  not 
practicable  for  all  practitioners.  The  facts  are  in  no  wise 
altered  thereby,  nor  need  the  lack  of  the  final  step  make 
the  ])rcccdin}^  less  possi?)lc  and  intelligent.  In  fact,  it  is 
to  the  general  recognition  of  the  facts,  acquired  with  the 
help  of  the  microscope  and  test  tube,  that  we  must  look 
for  an  accumulation  of  clinical  data  which  shall  make 
differential  diagnosis  possible  without  such  technical  means. 
The  result,  however,  hinges  upon  the  clear  comprehension 
of  the  fundamental  relation. 

Let  us  glance  at  the  broad  class  of  intoxications  occurring 
outside  of  the  tissues,  though  within  the  body,  as  for  ex- 
ample in  the  gastro-intestinal  tract.  To  such  poisonings 
I  will  limit  the  term  auto-intoxication. 

Existing  as  primary  or  accompanying  states,  they  are 
capable  of  inducing  manifold  indirect  results,  whose  de- 
scription, even  at  this  day,  is  prone  to  be  based  upon  organic, 
accidental  expression,  covered  by  a  name,  for  the  most 
part,  not  suggestive  of  the  etiology. 

In  such  relations  stand  much  of  the  bronchitis,  arthri- 
tis, enteritis,  asthma,  vasomotor  irregularities,  and  nerve 
manifestations,  as  in  headache,  or  neuralgia,  or  heart  ir- 
regularities. It  is  not  uncommon  to  have  several  of  these 
allied  conditions  coexisting,  or  alternating  in  the  same 
individual. 

How  long  shall  we  continue  to  regard  them  as  entities, 
ignoring  their  dependence  upon  absorption  of  toxins,  or 
toxic  irritation  of  local  surface,  with  reflex  development 
variously  distributed? 

Passing  to  a  third  group  of  conditions,  I  believe  we  may 
find  infinite  interest  in  tracing  the  kinship  that  exists  be- 
tween a  multitude  of  now-called  diseases,  whose  common 
genesis  is  also  intoxication,  but  as  a  result  of  per\'erted  or 
defective  metabolism. 

This    group    is    the    more    interesting,    as    the    more 


148  HENRY      BAIRD     FA  V  ILL 

important,  because  it  nearly  represents  the  essential  or  vi- 
tal possibilities  —  often  hereditary  —  of  the  individual;  not 
infrequently  presents  from  birth  to  age  a  consistent  series 
of  totally  unlike  phenomena,  which  are,  nevertheless,  expres- 
sions of  the  same  disturbance,  modified  in  form  by  age;  and 
often  is  represented  through  family  connection  by  occur- 
rences which  have  no  suggestion  of  likeness,  except  in  their 
relation  to  a  common  factor.  I  have  in  mind  the  following 
family  history  of  an  aged  lady  now  in  my  care ;  A  brother 
died  at  50  of  apoplexy;  (2)  another  brother  at  54  of  inter- 
stitial nephritis;  (3)  a  sister  suddenly  at  60,  supposedly  of 
coronary  sclerosis;  (4)  another  sister  of  intercurrent  dis- 
ease at  65,  having  had  post-apoplectic  paralysis;  (5)  a 
brother  at  about  70,  of  senile  dementia;  (6)  another  brother 
at  about  the  same  age,  of  senile  gangrene  of  the  extremities ; 
while  the  surviving  sister  has  mild  nephritis,  with  periods 
of  bronchial  inflammation,  due  to  the  varying  toxaemia 
associated  with  an  altered  bronchial  mucosa.  The  iden- 
tity of  process  in  these  seven  persons  is  striking.  The 
anatomical  condition  in  each,  arterial  degeneration;  in 
two  weakening,  in  two  occlusive,  in  two  destructive  of 
organic  structure  and  function,  and  one  yet  to  be  deter- 
mined, though  in  prospect  toxic.  But  the  kernel  of  the 
matter  is  in  the  cause  of  the  arterial  changes,  and  that  is  to 
be  sought  in  the  defects  of  chemic  change  occurring  through 
a  long  series  of  years,  perhaps  from  birth.  The  importance 
of  heredity  in  this  group  is  great. 

We  see  the  gouty  proclivities  of  the  parents  portrayed 
in  the  eczema  of  the  babe;  the  bilious  attacks  of  the  child; 
the  periodic  attacks  of  the  youth;  the  neuralgic  and  rheu- 
matic developments  of  maturity;  and  the  insidious  deteri- 
orations of  vital  organs  more  or  less  prematurely  developed, 
which  we  meet  with  surprise  and  call  Bright's  disease,  or 
heart  disease,   or  brain  disease. 

While  we  recognize  that  physiologic  trend  is  as  hered- 
itary as  form,  and  consequently  very  fixed,  we  must  recall 


M  [C  I)  I  ("  F  N  IC      AND      IMJI5LTC      HKAI.'III  149 

that  all  of  this  can  ori^n'natc  dc  novo.  Hence  the  question 
is,  not  what  is  the  form  or  location  of  this  disease,  but  what 
is  the  process  from  which  it  originates;  and  further  the  ques- 
tion,— To  what  extent  is  this  process  a  constant  factor  in 
the  Hfe  history  of  this  individual? 

Consider  a  fourth  group.  The  ductless  glands,  or,  some- 
what more  broadly,  the  interior  secretions,  so-called. 

What  we  do  not  know  about  these  secretions  and  their 
value  in  the  economy  should  not  be  allowed  to  discourage 
us  in  an  effort  to  arrange  what  we  do  know.  Latterly  we 
have  come  to  know  a  good  deal.  We  know  that  many  of 
them  are  of  vital  importance.  We  may  assume  that  all 
are  more  or  less  so. 

We  have  come  to  know  of  some,  as  the  thyroid,  that 
its  function  is  closely  associated  with  some  diseases  so- 
called,  so  of  the  suprarenal  capsule,  so  of  the  spleen  —  not 
as  organs  of  assimilation,  nor  as  participants  in  general 
metabolism,  but  as  furnishing  distinct  contributions  —  secre- 
tions, if  you  like  —  to  the  body,  for  purposes  yet  known  to 
us  only  in  their  miscarrying. 

We  feel  reasonably  sure  that  certain  abeyance  of  func- 
tion in  the  adrenals  will  induce — or  is  it,  permit? — Addison's 
disease.  If  it  is  so  potent  in  its  withdrawal,  what  shall 
we  argue  as  to  its  influence  if  it  be  present  in  excess?  Can 
we  conclude  there  is  no  excess?  Is  it  conceivable  that  it 
can  be  so  one-sided?     As  yet,  upon  this  we  have  no  light. 

Somewhat  clearer  is  our  light  upon  the  thyroid  gland. 
We  may  say  we  know  that  withdrawal  of  thyroid  influence 
(secretion)  beyond  a  certain  point  will  result  in  myxoed- 
ema.  We  have  a  well-marked,  unmistakable  picture  that 
is  typical  of  this  process. 

Where  does  myxoedema  commence  ?  How  long  a  period 
of  gradual  change  before  one  recognizes  the  difficulty? 
What  do  we  call  all  the  stages  of  the  difficulty  before  the 
final  picture?  Certainly  there  must  be  conditions  depend- 
ent upon  partial,  or  lessened  influence  of  thyroid,  long  before 


I50  HENRY      BAIRD     FAVILL 

the  typical  results  are  suggested.  I  contend  that  whether 
we  may  recognize  it  or  not,  there  is  a  sequence  of  conditions 
more  or  less  morbid  which  represent  the  various  degrees 
of  thyroid  lack. 

Does  not  our  diagnosis  hang  upon  such  close  discern- 
ments ? 

Let  us  take  the  obverse  picture,  the  typical  condition 
dependent  upon  over-influence  of  the  thyroid,  exophthalmic 
goiter. 

We  know  well  the  fully  developed  aspect.  Do  we  realize 
as  fully  the  pathway  toward  that  full  result  along  which  we 
may  expect  to  find  a  multitude  of  cases  whose  sufferings 
are  otherwise  inexplicable? 

These  two  extreme  conditions  of  bodily  perversion,  pre- 
senting the  utmost  contrast  both  of  form  and  function, 
reasonably  well  demonstrated  to  be  due  to  under-thyroid- 
ation  or  over-thyroidation,  respectively,  afford  the  most 
suggestive  text  along  the  line  which  I  suggest.  If  these 
extremes  exist,  a  priori  reasoning,  as  well  as  abundant  clini- 
cal experience,  will  declare  that  gradations  exist  between. 
Such  I  believe  to  be  the  fact.  If  true  of  thyroid  influence, 
is  it  not  probably  true  of  the  other  internal  secretions? 

May  we  not  hope  to  add  to  the  terms,  hyperthyroidation 
and  subthyroidation,  other  terms  equally  comprehensive? 

The  time  has  come  for  estimating  disease  as  an  expres- 
sion of  the  whole,  in  response  to  a  morbid  influence.  If 
the  local  features  become  of  importance,  accord  them  their 
rightful  attention,  but  let  us  struggle  against  the  folly  of 
regarding  a  hypertrophied  nasal  mucosa  as  explanatory 
of  hay  fever,  or  catarrhal  uterine  mucosa  as  of  different 
significance  from  other  catarrh,  or  either  as  independent 
of  constitutional  conditions. 

We  have  much  to  learn,  even  in  the  simple  field  of  symp- 
tomatology. Our  grasp  of  significant  phenomena  is  in  a 
measure  weakened  by  the  strong  current  toward  technical 
methods.     I  suspect  we  have  decidedly  retrogressed  from 


MEDICINE      AND      FMJ  [U.  I  C;      11  IC  ALT  II  151 

the  sym])U)in  rcadinj^  of  our  j predecessors,  and  that  we  are 
not  as  incessantly  building  our  vast  materials  into  usable 
forms  as  the  time  and  opportunity  demand. 

A  fixed  symptom  is  a  boon :  not  that  we  want  fixed  rules 
for  diagnosis,  but  we  want  knowledge  of  relative  weight 
and  projjortion,  so  that  the  path  may  be  blazed  without 
diversion  and  be  followed  with  confidence. 

It  is  not  necessary  in  a  given  case  that  I  know  exactly 
why  a  definite  pain  in  the  thigh  invariably  predicts  an 
intestinal  explosion.  It  is  quite  necessary,  however,  that  I 
do  not  accept  them  as  independent  and  treat  one  as 
rheumatism  and  the  other  as  colic. 

It  is  not  necessary  that  I  be  able  to  explain  the  method 
of  production  of  angina  pectoris.  It  is  quite  important 
that  I  realize  in  a  given  subject  that,  in  spite  of  his  stiff 
aorta  and  sclerotic  coronaries,  he  has  or  has  not  angina, 
according  as  he  is  or  is  not  overwhelmed  with  gouty  accu- 
mulations. 

These  are  suggestions  which  I  wish  to  urge,  though 
superficially  and  inadequately  presented. 

A  broader  interpretation  of  morbid  phenomena,  which 
will  recognize  the  interdependence  of  functions  and  seek 
to  systematize  the  presentations,  is  the  work  before  us.  It 
will  not  be  done  in  the  laboratory.  It  will  not  be  done  in 
the  hospital.  It  will  be  done  in  the  industrious  drudgery  of 
private  practice,  but  it  must  be  first  an  acknowledged  task. 

The  mass  of  pathologic  data  poured  upon  us  constantly 
gives  rise  to  the  impression  that  pathology  is  becoming  more 
and  more  complicated.  In  the  confusion  of  production  its 
classification  has  been  rather  disjointed  and  its  conclusions 
unstable,  but  the  principles  of  patholog>"  are  growing  fewer 
and  simpler.  The  aspect  due  to  the  peculiarity  of  local 
response  does  not  constitute  a  pathologic  entity  and  should 
merge  at  once  into  the  composite  picture.  We  must  recog- 
nize that  every  organ  and  tissue  has  its  own  reaction  to  the 
general  morbific  influences  which  occur. 


152  HENRY      BAIRD     FAVILL 

Anatomically  or  organically  considered,  the  array  of 
diseases,  if  we  so  designate  them,  is  a  multitude.  It  is 
only  rational,  however,  to  carry  our  identification  back  by 
careful  analysis  to  the  simple  systemic  vice  or  defect  or 
attack  to  which  our  outbreak  is  reaction. 

Regarding  then  the  systemic  equilibrium  as  the  central 
thought  in  forming  a  diagnosis,  it  follows  that  the  founda- 
tion of  a  diagnosis  is  knowledge  of  the  normal.  This  sounds 
like  a  truism,  but  I  am  serious  in  my  statement  that  in  my 
observations  of  educated  men,  and  in  my  experience  as  an 
educator  of  students,  the  most  pronounced  defects  are 
here  evident. 

All  scientific  effort  is  recognizing  this  truth.  In  all  di- 
rections it  is  seen  that  between  the  class  of  investigators 
who  study  the  past  result  —  the  dead  —  and  the  class  who 
study  only  the  morbid  and  diseased  individual  or  class,  the 
path  of  progress  becomes  dubious.  We  gain  information 
thus;  we  know  and  classify  results;  but  we  learn  little  of 
process,  and  hence  acquire  little  power  either  in  foreseeing 
or  averting  results. 

It  is  as  true  in  medicine  as  in  social  science  that  the 
laws  determining  bodily  equilibrium  are  primary  to  the  study 
of  disease;  hence  in  closing  I  would  direct  your  attention 
to  the  obvious  fact  that  in  establishing  the  lines  upon  which 
comprehensive  diagnosis  can  be  made,  we  penetrate  to  the 
earliest  departures  from  the  normal,  and  inevitably  and 
permanently  subordinate  our  interest  in  the  pathologic  to 
the  desire  to  maintain  the  normal,  and  thereby  put  the 
crowning  glory  upon  the  science  of  medicine. 


M  E  D  I  C  1  N  r<:      AN  D      P  (J  I'>  L  I  C      H  K  A  L  l  \\  i  53 


Printed,  Medicine,  SepLcmlxT,  1901. 

CHOREA:   ESPECIALLY    IN    RI^I>ATION    TO 
RHEUMATLSM    AND    ENDOCARDITIS 

CHOREA  has  been  regarded  in  general  as  a  funetional 
disease.  Whatever  was  meant  by  that  term,  the 
basis  of  that  view  has  been  its  transient  character, 
its  perversion  rather  than  its  destruction  of  function,  and 
its  lack  of  morbid  anatomy. 

No  question  is  more  surrounded  with  contradictions 
than  that  which  we  must  ask  at  the  outset  of  this  discus- 
sion: What  is  functional  disease?  Without  attempting 
to  answer,  we  may  reflect  upon  the  various  factors  that  are 
concerned  in  our  answer  at  any  given  period. 

To  start  with,  the  designation  is  relative  and  subject  to 
modification  as  knowledge  grows.  Hence  the  conception 
has  only  stability  for  such  periods  as  afford  no  advance  in 
knowledge  and  classification;  in  fact,  it  is  always  provisional. 
It  stands  primarily  in  antithesis  to  the  term  structural  — 
organic  —  and  in  that  relation  of  course  recedes  before  deeper 
acquaintance  with  pathologic  change. 

We  may  readily  conceive  that  in  a  strict  sense  there  can 
be  no  disease  which  has  not  some  alteration  in  molecular 
arrangement;  hence,  which  is  not  finally  structural.  The 
logic  of  our  progressive  change  of  view  is  to  such  a  con- 
clusion. 

Long  before  such  a  point  is  reached,  however,  we  shall 
come  upon  another  point  of  view:  To  what  extent  are 
structural  changes  the  expression  of  the  exposure  of  tissue 
to  altered  conditions,  probably  chemical?  and  hence  are 
not  such  structural  changes  only  partially  explanatory*  of 
disease  manifestations?  And  out  of  this  reflection  springs 
the  question:  ^^Tiat  will  a  given  exposure  induce  in  the 
way  of  symptoms,  at  various  stages  of  the  structural  changes 


154  HENRY      BAIRD     FAVILL 

consequent  upon  it?  At  once  we  see  that  not  only  do  the 
most  varied  groups  of  symptoms  become  alHed  in  reactions 
of  different  tissues  to  a  common  cause,  but  we  may  fairly 
infer  that  the  play  of  the  chemical  influence  upon  the  organic 
mechanism  will  result  in  changing  pictures  as  the  structures 
progressively  alter ;  and  therefore  that  the  same  organ  react- 
ing to  a  given  influence  in  altered  function,  changing  its  own 
structure  under  the  same  stimulus,  will  present  at  various 
stages  of  its  pathologic  progress  perversions  of  functions,  so 
various  as  to  cause  them  to  receive  quite  distinct  con- 
sideration and  description.  Accepting  the  necessity  for 
such  treatment,  we  need  not  lose  sight  of  the  simple  factor 
in  the  reaction,  nor  forget  that  we  are  dealing  with  pro- 
gressive processes. 

To  conclude,  therefore,  as  we  may  in  future,  that  all 
disease  is  organic,  even  though  we  fully  comprehend  the 
change  in  structure,  by  no  means  satisfies  the  demands  of 
our  problem.  It  is  not  ultimate,  and  the  inquiry  must  go 
much  deeper. 

So  it  appears  that  there  is  no  place  for  the  term  "func- 
tional" except  as  an  expression  of  one  of  two  views:  either 
describing  a  reaction  whose  structural  basis  is  unknown, 
or  as  implying  the  possibility  of  response  to  morbid  influ- 
ence without  permanent  organic  change.  In  either  event 
the  morbific  influence  is  becoming  a  more  essential  factor, 
and  we  find  steadily  less  opportunity  to  reckon  without  it. 
By  such  a  pathway  have  we  come  to  the  recognition  of  the 
influences  which  we  call  toxic,  and  even  the  term  septic 
and  the  idea  of  infection  find  their  interpretation  in  this 
broader  intoxication.  It  is  only  in  such  generalization  that 
we  can  reach  any  standpoint,  even  provisionally,  from  which 
to  regard  this  very  interesting  but  obscure  topic  under 
discussion. 

Chorea  has  run  the  whole  gamut  of  speculation  as  to  its 
nature.  Functional,  embolic,  toxic,  infectious,  degenera- 
tive — all  possible  views  have  been  advocated  strenuously. 


M  ic  I)  I  (•  I  N  10    AND    I' n  in.  f  f    ni;Ai,'[(i        15=; 

We  arc,  in  fnvl,  not,  in  ijosil.ioii  lo  form  .'i  conchision  about 
it.  Each  aspect  of  the  case  lends  strength  to  one  or  another 
of  the  hypotheses.  None  of  them  are  universal  in  appli- 
cation, and  hence  one  of  three  conclusions  is  necessary: 
either  there  are  numerous  different  causes,  or  there  is  a  cau.se 
not  yet  ascertained,  or  there  are  cooperative  causes.  Our 
use  of  the  term  will  refer  solely  to  Sydenham's  chorea,  which 
is  the  only  real  chorea  clinically.  Even  with  regard  to  this 
there  is  a  wide  difference  of  opinion  as  to  whether  there  are 
not  various  kinds.  In  view  of  the  fact  that  we  know  so 
little  of  the  basis  of  any  kind,  it  is  at  present  rather  a  fruitless 
contention. 

Clinically  it  is  a  well  defined  affection  too  familiar  to 
justify  one  in  its  description.  Let  it  suffice  that  it  is  fre- 
quent, serious,  complicated,  and  at  times  amongst  the 
gravest  of  diseases  of  the  young.  Whence  comes  it?  Out 
of  all  manner  of  conditions,  to  be  designated  as  debilita- 
ting, excited,  or  disordered.  There  is  indeed  little  in  com- 
mon in  circumstantial  facts.     That  aspect  is  protean. 

At  an  early  date  the  apparent  association  of  chorea  with 
rheumatism  led  to  much  discussion  of  the  topic.  The  ques- 
tion has  been  vigorously  argued.  By  some  it  is  maintained 
that  it  is  allied  to  rheumatism  in  general;  by  others  that 
only  that  rheumatism  which  had  endocarditis  as  a  com- 
plication, presumably  making  the  endocardial  lesion  the 
connecting  link;  by  others  the  whole  relation  of  cause  and 
effect  is  denied. 

First,  what  are  the  facts?  In  a  very  large  proportion 
of  closely  analyzed  cases  associated  rheumatism  is  to  be 
inferred  from  various  arthritic  or  similar  manifestations. 
These  arthritic  developments,  however,  are  distinctly 
divisible  into  the  attacks  which  coincide  with  the  chorea 
and  those  that  precede  it  by  a  variable  but  considerable 
interval.  ]\Iuch  more  marked  is  the  association  of  endo- 
carditis with  chorea  —  that  is  to  say,  endocardial  lesions, 
not  necessarily  recent.     Even  so,   the  explanation  of  the 


156  HENRY      BAIRDFAVILL 

coincidence  is  not  ready,  and  when  one  considers  that  the 
various  morbid  outbreaks  in  a  number  of  these  cases  were 
separated  by  long  intervals,  it  is  with  hesitation  that  one 
concludes  that  there  is  a  causal  relation. 

Let  us  digress  for  a  moment  and  observe  what  is  true  of 
endocarditis.  That  it  may  be  due  to  infective  invasion,  in 
the  course  of  various  diseases,  there  is  no  question;  that  it 
may  be  due  to  participation  in  the  reaction  to  the  morbific 
agent  of  rheumatism  there  is  no  question.  Whether,  in 
pursuance  of  the  suggestions  therein  contained,  rheumatism 
is  an  infection  is  beside  the  point.  We  see  that  endocarditis 
is  associated  with  rheumatism.  Is  it  a  complication?  By 
no  means.  It  is  rheumatism.  Nothing  is  more  important 
than  that  we  divest  ourselves  of  the  idea  that  endocarditis 
is  a  sequel  of  rheumatism.  Often,  very  often,  in  children, 
it  is  the  only  manifestation  of  rheumatism,  and  more  often 
the  arthritis  that  coexists  or  precedes  is  so  slight  as  to  escape 
attention.  Likewise,  with  enormous  frequency,  the  endo- 
carditis escapes  attention  in  the  absence  of  arthritis. 

The  observation  is  well  verified  that  endocarditis  is  essen- 
tially the  rheumatism  of  the  young.  Yet  what  is  the  re- 
lation between  the  cardiac  and  arthritic  manifestations? 
Gradually  evidence  is  accumulating  that  rheumatism  is  a 
septic  process;  whether  of  one  form  of  coccus  or  another 
does  not  matter  to  us  at  this  time.  The  fact,  if  established, 
will  serve  to  simplify  and  harmonize  the  relationship  between 
the  joint  and  cardiac  lesions. 

The  known  relation  of  cardiac  disease  to  septic  and  in- 
fective processes  has  logically  demanded  such  a  nature  for 
rheumatism  as  a  causal  antecedent  or  collateral  process. 
The  toxic  foundation  of  rheumatism,  though  by  no  means 
disposed  of  by  such  demonstrations,  receives  an  important 
coordinate  factor.  Manifestly,  if  it  is  demonstrated  that 
the  arthritis  as  well  as  the  endocarditis  is  of  infective 
origin,  the  problem  will  still  be  open.  Is  there  an  under- 
lying   toxemia?     Clinical    observations,    it   seems    to    me, 


M  EI)  I  C  I  N  F<:      AND      FMJIU.  IC      H  lO  A  I.  T  H  157 

abundantly  suggest  this  to  ])c,  the  case.  Yet  it  is  simple  to 
overdo  the  toxemin  view,  by  reason  of  its  very  generalizing 
character. 

But  more  specifically,  to  touch  upon  that  ground,  which 
if  it  were  not  most  important  would  be  trite,  the  relation 
between  rheumatism  and  gout,  what  is  our  view?  i.  Are 
we  not  reasonably  sure  that  much  of  the  clinical  showing 
of  gout,  of  all  sorts,  is  chemical  —  that  is,  toxic?  If  so,  we 
can  not  disregard  its  value  in  this  problem.  2,  Are  we  not 
reasonably  assured  that  there  are  various  conditions  of  dis- 
ease in  which,  alternately  or  together  with  a  form  of  rheu- 
matism not  typical  gout,  we  find  a  cause  in  the  gastro- 
intestinal chemic  perversions?  Instances  of  alternating 
diarrhoea,  asthma,  pseudo-angina,  bronchitis,  and  arthritis 
I  have  heretofore  reported.  These  I  believe  to  be  more 
or  less  correlated  evidences  of  a  common  toxemia.  Of  the 
possibility,  nay,  the  frequency,  of  such  complex  pictures  I 
am  persuaded. 

The  question  may  fairly  be  asked.  Is  the  arthritis  in 
such  cases  identical  with  that  of  rheumatism?  wSo  far  as 
my  observation  goes  it  is  somewhat  regularly  subacute  or 
chronic,  and  has  not  been  shown  to  be  septic.  Clearly,  it 
may  be  different,  but  my  point  is  not  altered  thereby. 
The  alternation  or  coincidence  of  arthritis  and  neurotic 
manifestations,  repeated  to  the  point  of  moral  certainty, 
no  matter  how  obscure  the  cause,  is  the  fact  I  wish  to  set 
forth  first.  I  am  quite  sure  this  happens.  Hence  I  am 
quite  prepared  to  regard  a  neurosis,  which  can  be  clinically 
associated  with  arthritis,  as  being  also  etiologically  related. 
The  record  of  clinical  behavior  of  the  body  reacting  to  toxins 
is  full  of  surprising  facts,  and  I  do  not  at  all  share  the  skep- 
ticism of  those  who  see  in  the  utter  unlikeness  of  the  symp- 
toms a  necessary  separation  as  to  origin.  Secondly,  I  wish 
to  call  3"Our  attention  to  the  fact  that  toxic  agents  are  pro- 
duced under  widely  different  conditions,  and  that  we  have 
no  reason  to  regard  the  influence  of  toxins  as  essentiallv 


158  HENRY     BAIRD     FA  V  ILL 

different,  though  of  different  origins.  There  is  no  reason, 
for  example,  why  a  chemical  substance,  the  result  of  acid 
fermentation  in  the  intestines,  a  chemical  substance,  the 
result  of  defective  proteid  metabolism  in  the  tissues,  and 
a  chemical  substance,  the  result  of  the  physiological  activity 
of  bacteria,  should  be  held  as  anything  but  chemical  agents. 
They  are  capable  of  producing  effects,  dependent  upon 
character,  amount,  access,  concentration,  condition  of  re- 
sistance of  the  body  attacked,  and,  of  course,  many  other 
factors.  What  will  this  poison  do  to  this  cell,  under  these 
conditions?  It  is  not  a  complex  statement.  The  point 
of  view,  however,  to  my  mind  is  important,  and  clinical 
observation  furnishes  us  with  plenty  of  such  significant 
relations. 

Unfortunately,  we  have  no  consistent  observation  as  to 
the  morbid  conditions  that  exist  during  the  attacks  of 
chorea.  The  seat  is  doubtless  cortical,  and  the  post-mortem 
findings  have  been  not  at  all  uniform  and  are  very  meager. 
Recently  a  few  cases  have  been  thoroughly  worked  up  which 
lend  weight  to  the  view  that  the  neurosis  is  not  toxic,  that 
is  of  remote  origin,  but  that  the  infective  agent  is  really 
at  work  in  the  brain  as  in  the  joints  and  heart.  Such  a 
demonstration,  if  it  come,  will  of  course  simplify  the  con- 
ception so  far  as  these  disease  manifestations  are  concerned, 
but  will  not  dispose  of  the  facts  which  are  now  more  or 
less  stumbling-blocks. 

In  spite  of  the  fact  that  the  light  that  comes  tends  to 
identify  both  rheumatism  and  chorea  with  infectious  proc- 
esses in  some  way,  the  most  serious  obstacle  to  considering 
them  as  one  in  origin  lies  in  the  fact  that  only  a  part  of  the 
cases  of  chorea,  variously  stated  as  from  1 8  to  50  per  cent, 
have  any  history  of  arthritis.  As  bearing  upon  this  point, 
however,  it  must  be  said  that  the  rheumatic  arthritis  of 
children  is  regularly  so  slight  that  defective  observation  and 
forgetfulness  may  readily  account  for  a  very  large  error  in 
this  respect.     This  suspicion  may  be  emphasized  by  the 


M  K  1)  T  f  T  N  K      ANT)      P  IT  FU,  I  C      Ff  E  A  L  T  H  i  59 

fact  that  endocardial  lesion;;'  indclildc  marks  arc  very  much 
more  uniformly  found  in  chorea  than  is  a  history  of  arthritis. 
Couple  with  this  the  fact  that  the  arthritis  bclonginj^  to 
endocarditis  is  in  a  large  number  of  cases  either  wanting  or 
overlooked,  and  we  have  reason  to  distrust  the  statistics 
which  report  only  "undoubted"  histories. 

Even  though  the  discrepancy  cannot  be  overcome  —  as- 
suming that  many  cases  of  chorea  have  harl  no  arthritis  — 
does  it  follow  that  there  is  no  relation  ?  Assuredly  not. 
Are  we  not  agreed  that  endocardial  rheumatism  may  be 
independent  of  arthritic  rheumatism?  If  so,  why  not 
choreic  rheumatism?  We  must  admit  the  toxin.  We  must 
admit  the  possible  neurosis  the  result  of  toxic  action.  Why 
not  the  chorea,  from  rheumatic  toxin  without  arthritis? 
Clearly,  there  is  no  reason  why  not.  All  that  remains  is 
the  demonstration. 

Are  we  not  also  agreed  that  there  is  endocarditis  from 
many  infections  besides  rheumatism,  if  indeed  rheumatism 
be  an  infection?  There  are  many  forms  of  arthritis  besides 
that  of  rheumatism,  of  infective  origin.  We  have  gonor- 
rheal, pneumococcic,  pyemic.  In  fact,  how  many  have  we? 
All  are  more  or  less  subject  to  confusion  under  the  name  of 
rheumatism.  Indeed,  we  must  hold  this  subject  lightly, 
prepared  to  change  our  views  on  all  the  factors  involved, 
but  with  a  clear  recognition  of  the  fact  that  the  evidence 
is  accumulating  that  chorea,  arthritis,  and  endocarditis 
are  (i)  related  to  each  other,  (2)  related  to  infectious  cause 
or  causes. 

We  have  no  reason  to  assume  that  this  is  the  onh'  cause. 
We  have  no  ground  for  stating  that  the  same  agent  that 
induces  the  arthritis  induces  the  chorea.  We  have  reason 
for  demanding  that  an  explanation,  to  be  accepted  as  final, 
must  account  for: 

1.  The  decided  heredity  in  chorea  —  76  per  cent  of 
neurotic  family  history. 

2.  The  preponderance  of  association   of  chorea  with 


l6o  HENRY     BAIRD     FA  V  ILL 

what  we  clinically  call  rheumatism,   including  its  predis- 
posing factors. 

3.  The  various  toxic  relations  not  only  of  chorea  but  of 
rheumatism,  now  thought  not  to  be  septic. 

4.  The  most  obscure,  the  fact  that  clinically  distinct 
chorea  has  followed  upon  emotion  and  fright,  at  times  im- 
mediately, in  cases  sufficient  to  demand  explanation. 

It  is  not  wise  to  be  too  technical  in  this  analysis.  One 
can  erect  barriers  to  any  extent  upon  any  one  of  these 
obstacles.  A  broad  view  is  what  we  want,  into  which  will 
fit  the  various  demonstrations  as  they  come  along.  The 
impression  is  not  to  be  escaped  that  we  are  dealing  with 
related  conditions.  It  grows  more  probable  that  they  are 
infective.  Let  us  not  be  confused  by  the  contention  as  to 
whether  the  infection  is  simple  or  ' '  mixed ' ' ;  nor  by  that  as 
to  whether  we  have  various  kinds  of  chorea  or  arthritis ;  nor 
by  the  difficulty  of  explaining  the  purely  neurotic  features. 

The  conclusion  is  warrantable  that  endocarditis,  chorea, 
and  arthritis  are  coordinate  manifestations  of  disease  con- 
ditions, peculiar  to  the  young  in  that  order,  and  that  an 
important  element  in  causation  is  infection. 

Beyond  this  statement  we  cannot  go,  but  it  is  well  if  we 
are  justified  in  going  this  far  that  we  agree  about  it.  There 
has  been  great  opposition  to  the  adoption  of  the  theory  of 
a  relation  between  chorea  and  rheumatic  conditions.  One 
must,  however,  face  the  facts,  and  the  significance  of  recent 
demonstrations  adds  weight  to  the  view  that  by  some 
combination  of  etiologic  factors  the  coincidence  of  chorea 
with  the  usual  manifestations  of  rheumatic  poison  deserves 
an  essential  rather  than  an  incidental  interpretation. 


M  I-:  1)1  (•  I  N  IC     AND      I'UIJLIC      II  E  A  I.  T  11  r6i 


Delivered,  Chieago  Medical  »Socicty,  October  8,  \<)<)2. 
Printed,  Chicago  Medical  Recorder,  November,  1902. 

TREATMENT  OF  TYPHOID  FEVER 

As  you  will  note,  the  title  of  this  discussion  has  been 
/"A  carelessly  designated,  because  it  might  be  supposed 
to  lap  over  upon  the  territory  so  ably  discussed  by 
Dr.  Walls,  which  it  is  not  my  purpose  to  do,  nor  will  time 
permit  me  to  discuss  typhoid  fever  at  large  and  in  all  its 
manifold  details.  It  is  obvious,  in  view  of  the  few  minutes 
allotted  to  me,  that  it  would  be  impossible  to  more  than 
skim  over  the  various  phases  of  the  subject,  and  such 
treatment  would  be  unsatisfactory  and  unprofitable.  It 
seems,  therefore,  justifiable  to  take  up  the  question  of 
typhoid  fever  in  relation  to  its  therapeutics,  by  discussing 
some  important  and  salient  points.  I  trust  I  may  be  par- 
doned for  speaking  extemporaneously,  for  it  enables  me  to 
deal  more  satisfactorily  with  the  subject  in  these  few 
minutes. 

If  I  were  to  announce  what  the  proper  treatment  of 
typhoid  fever  is,  according  to  my  view,  I  should  immediately 
have  a  host  of  members  disagreeing  with  me.  I,  therefore, 
propose  to  confine  what  I  have  to  say  on  this  subject  to  a 
discussion  of  hydrotherapy,  and  that  particular  phase  of 
it  which  is  the  most  valuable. 

I  think  it  will  be  agreed  in  general  by  those  who  are 
disposed  to  discuss  matters  consistently,  and  certainly  by 
a  large  proportion  of  those  who  are  teaching  and  practic- 
ing in  hospitals,  that  hydrotherapy  of  the  bath  t^-pe  is  dis- 
tinctly a  proper  thing  in  typhoid  fever.  Is  that,  however, 
the  consensus  of  opinion  in  the  profession  as  evidenced  by 
their  practice?  If  it  is,  I  am  thoroughly  mistaken,  and  my 
remarks  will  be  superfluous.  If  it  is  not,  it  furnishes  the 
theme  of  what  I  have  to  say.  Statistically,  this  question 
hardly  deserves  discussion.  The  statistics  on  this  subject 
7 


l62  HENRY      BAIRD     FA  V  ILL 

have  grown  so  large  and  are  so  overwhelming  in  indicating 
that  the  typical  bath  treatment,  or  the  so-called  Brand 
treatment  of  typhoid,  yields  decidedly  a  decreased  mor- 
tality, that  no  one  disputes  them.  Statistics  are  always 
deceptive,  yet  on  this  point  they  are  so  voluminous  that 
we  can  not  ignore  them.  It  is  to  be  said  in  fairness  to  those 
who  oppose  the  bath  treatment,  that  the  statistics  of  the 
other  forms  of  expectant  treatment  are  imperfect.  In 
other  words,  the  statistics  bearing  upon  the  bath  treatment, 
as  compiled  from  various  parts  of  the  world,  are  based  upon 
the  best  and  most  efficient  use  of  baths,  whereas  the  con- 
verse is  true  of  the  statistics  of  other  practice,  which  includes 
all  sorts  of  distinctly  bad  treatment.  However,  passing 
that  by  as  a  necessary  fallacy  that  lies  in  statistics  generally, 
let  us  consider  what  we  are  talking  about. 

What  do  we  mean  by  the  bath  treatment  of  typhoid 
fever?  Let  us  take  the  typical,  original  Brand  bath.  It 
may  be  defined,  please  notice,  as  the  vigorous  rubbing  and 
manipulation  of  a  typhoid  patient,  well  immersed  in  water 
of  a  temperature  varying  from  sixty  to  eighty  degrees.  I 
purposely  put  it  in  that  form  because  I  wish  to  emphasize 
the  fact  that  the  manipulation  in  the  bath  is  an  essential 
part  of  the  process,  and  that  the  temperature  and  other 
features  of  the  water  are  much  more  subject  to  variation 
than  the  manipulation.  That  is  what  we  mean  typically 
by  the  bath  treatment. 

What  is  the  theory  upon  which  this  treatment  is  now 
carried  on?  Unquestionably,  the  theory  originally  with 
regard  to  this  treatment  was  that  it  was  an  efficient,  essen- 
tial antipyretic  measure.  Is  it  now  generally  so  regarded 
as  a  primary  antipyretic  measure  ?  I  think  it  will  be  agreed 
by  those  who  have  experience  in  the  matter,  that  although 
the  antipyretic  value  of  the  bath  is  great  and  important, 
it  is  a  mistake  to  centralize  our  attention  upon  its  anti- 
pyretic effect.  The  theory  of  this  treatment  is  that  its 
effect  upon  the  patient  is  two-fold,  first,  sedative;  second. 


M  re  I)  I  (' [  N  ic     AND     I' i;  I'.  I.  If      (ii;ai.'ii[        163 

tonic.  Practical  observation  hy  cvcrylxKly  who  has  had 
experience  in  this  direction  will  enable  him  to  draw  this 
conclusion:  That  an  adult  patient  who  is  subjected  to  an 
intelligent  administration  of  a  cold  bath  in  typhoid,  typically 
and  regularly,  shows  marked  sedative  effects,  as  manifested, 
first,  by  a  feeling  of  comfort,  as  against  a  previous  feeling 
of  malaise;  second,  manifested  by  a  tendency  to  sleep,  as 
contrasted  with  previous  restlessness  and  inability  to  sleep. 
ThOvSe  conditions  are  distinctly  marked  in  the  ordinary, 
regular,  typical  bath.  The  second  phase  of  this  important 
condition  is  said  to  be  tonic.  Upon  what  are  we  justified 
in  basing  that  conclusion?  First,  an  im]jrovement  in  the 
cerebral  condition,  a  condition  of  clearness  of  mind  as 
against  hebetude;  of  alertness  as  against  indifference;  of 
comfort,  physical  and  psychical,  as  against  distress.  There 
is  no  question  that  this  is  a  fair  index  of  improved  tone. 

Again,  with  reference  to  the  digestive  tract.  There  is 
typically  a  better  digestion,  as  evidenced  in  two  directions, 
namely,  by  the  decidedly  less  typhoid  character  of  the 
tongue,  and,  second,  by  the  almost  invariably  less  tendency 
to  meteorism.  I  do  not  wish  to  go  outside  of  the  facts  in 
making  these  statements,  but  I  think  they  are  borne  out  by 
experience.  All  of  these  various  phenomena  incident  to 
the  results  of  baths  in  typhoid,  whether  the  patients  recover 
or  whether  they  do  not,  have  been  ascribed  by  those  who 
theorize  upon  this  matter  to  an  improved  elimination  on 
the  part  of  the  patient.  In  other  w-ords,  the  bath  is  sup- 
posed to  operate  as  a  tonic,  primarily  by  a  sharp  stimulus 
to  the  nervous  system;  secondarily,  as  an  eliminant  of 
marked  power  over  the  individual  in  fever. 

Whether  this  is  so  or  not  is  inferential.  It  is  based  upon 
obvious  improvements  in  what  we  have  been  regarding, 
I  think,  and  are  justified  in  regarding,  as  the  evidences  of 
toxemia.  Two  facts  stand  together  to  bear  out  this  idea 
of  better  elimination.  First,  that  almost  invariably  there 
is  a  marked  improvement,  by  which  I  mean  an  increase,  in 


i64  HENRY      BAIRD     FAVILL 

the  excretion  of  urine.  That  is  typical,  regular  and  reliable. 
The  other  is  something  which  I  do  not  know  by  experience 
but  which  statistically  or  experimentally  is  presented  to 
us :  the  fact  that  the  toxicity  of  the  urine,  after  and  in  con- 
nection with  the  bath  treatment,  is  said  to  be  increased, 
indicating  larger  excretion  of  toxins.  Of  this  there  is  little 
doubt.  At  any  rate,  I  am  not  in  a  position  to  deny  it. 
If,  then,  this  is  the  theory  that  underlies  these  baths,  and 
the  marked  improvements  of  condition,  and  if  time  shall 
prove  this  theory  to  be  sound,  there  can  be  little  doubt  that 
the  bath  treatment  will  be  placed  on  a  solid  foundation. 

There  are,  however,  modifications  of  the  bath  treatment 
which  it  is  worth  our  while  to  discuss.  Typically,  a  patient 
is  taken  out  of  his  bed,  with  a  temperature  of  103°  -4°  -5°, 
as  the  case  may  be,  and  suddenly  immersed  in  a  bath  of  a 
temperature  of  75°  or  80°.  It  is  understood  by  foreign 
authorities  and  some  of  the  best  authorities  in  this  country 
that  this  plan  yields  better  results  than  does  any  modifi- 
cation thereof.  My  experience  with  that  form  of  immersion 
is  so  much  less  than  my  experience  with  another,  that  it  is 
with  some  diffidence  I  express  the  opinion,  namely,  that 
there  is  a  modification  of  the  Brand  treatment  which,  in 
its  clinical  results,  is  as  good,  and  which,  in  its  practical 
results,  is  much  better. 

In  hospital,  for  two  reasons,  a  modification  is  often 
pursued.  One  is  that  the  actual  manual  manipulation,  the 
help  necessary  to  immerse  patients  in  the  tub,  take  them 
out,  and  dispose  of  them  in  that  way,  is  considerable,  so  much 
so  as  to  essentially  make  it  almost  impracticable  in  many 
hospitals.  It  would  not  be  impracticable,  of  course,  in  a 
large  and  well  regulated  hospital.  It  is  not  an  unfeasible 
thing  to  administer  the  Brand  treatment,  pure  and  simple, 
in  a  hospital. 

In  my  own  experience  I  have  departed  slightly  from  the 
Brand  method  of  treatment,  for  this  reason,  that  my  experi- 
ence has  taught  me  what  I  believe  to  be  true,  namely,  that 


M  K  I)  I  (■  F  N  !<:      AND      FMJ  H  F,  I  C      IFFCAF.TFF  165 

as  good  results  crui  l)e  ohiriiiicfl  hy  another  method  which 
I  will  describe  in  a  moment.  Private  practice  demands  a 
modification  of  the  Brand  method.  The  practical  affairs  of 
life  have  to  be  considered.  The  second  reason  therefore 
is  tliat  our  nurses,  who  are  to  ])e  educated  for  private  prac- 
tice, should  be  educated  in  practical  ways  with  that  in  view, 
and  it  is  my  opinion  that  it  is  as  well  for  us  to  use  a  modifi- 
cation which  I  believe  as  good,  during  their  training  in  our 
hospitals.  You  are  all  familiar  with  the  construction  in 
the  bed  of  a  tub  of  any  kind,  either  the  Haven  or  the  Burr, 
or  any  other  form;  instead  of  immersing  the  patient  in  water 
by  dropping  him  in,  you  pour  the  water  over  him,  having 
sufficient  water  to  submerge  the  patient.  You  cover  him 
with  a  reasonable  amount  of  water.  The  water  in  such  a 
tub  heats  more  quickly  than  in  the  ordinary  bathtub,  and 
in  consequence  the  measures  for  cooling  the  water  have  to 
be  somewhat  different.  Where  the  water  is  put  in  at  a 
reasonable  temperature,  it  can  be  cooled  by  adding  pieces 
of  ice  repeatedly  until  the  temperature  is  reduced  to  the 
desired  point  and  maintained  there.  The  patient  is  kept 
in  the  tub  for  a  variable  length  of  time  and  is  constantly 
rubbed.  Almost  any  man  who  saw,  for  the  first  time,  a 
typhoid  patient  in  a  tub  of  water  would  say  that  the  patient 
was  being  maltreated,  for  the  reason  that  he  becomes 
cold,  shivers,  is  blue,  has  distressing  symptoms,  and  fre- 
quently implores  us  to  take  him  out.  This,  however,  is 
not  really  the  case  if  we  are  accustomed  to  it.  It  looks  like 
maltreatment,  and  it  takes  some  experience  to  go  on  with 
it  in  the  face  of  that,  but,  after  all,  when  a  patient  is  once 
taken  out  of  such  a  bath,  and  rolled  in  a  blanket,  he  goes 
immediately  into  a  state  of  repose,  perhaps  sleep,  and 
sometimes  continues  sleeping  for  hours.  His  pulse  grows 
slower  and  stronger,  his  respiration  deeper  and  calmer,  and 
his  temperature  falls  more  or  less. 

That  form  of  bath  is  practicable  in  any  house  under  any 
circumstances,  where  there  is  one  person  who  can  devote 


i66  HENRY      BAIRD      FA  V  ILL 

his  attention  to  the  patient,  whether  it  is  a  trained  nurse 
or  not.  I  say  this  with  emphasis,  because  it  is  true,  and 
because  the  generally  prevalent  idea  is  that  it  is  not  true. 
It  is  of  the  greatest  importance  that  we  come  to  recognize 
that  this  can  be  done  in  any  private  house  where  there  are 
any  facilities  at  all.  I  do  not  mean  now  necessarily  the 
surroundings  of  opulence. 

The  great  difficulty  in  having  this  form  of  treatment 
adopted  arises  from  the  fact  that  the  majority  of  patients 
with  typhoid  fever  recover;  hence,  all  of  us  are  so  accustomed 
to  treating  them  through  to  recovery,  that  we  expect  them 
to  recover  without  so  much  fuss.  What  fuss  do  we  make? 
As  they  go  on  and  get  sicker  and  sicker  we  sponge  and  pack 
them;  we  do  all  sorts  of  quasi-therapeutic  things  to  reduce 
temperature.  Does  anybody  say  that  sponging  or  packing 
is  distinctly  tonic,  sedative,  or  eliminative?  It  may  be, 
but  that  is  not  the  idea.  The  idea  of  these  collateral,  alter- 
native procedures  is  to  reduce  temperature.  But  the  reduc- 
tion of  temperature  is  not  the  point.  The  condition  is  the 
point,  and  I  wish  to  say  without  equivocation  and  with 
the  firmest  conviction,  that  the  condition  incident  to  the 
bath  treatment  is  beyond  any  question  better  than  the 
condition   incident   to   any   other    form    of    hydrotherapy. 

It  is  rare  in  these  days  in  hospital  treatment  that  we  see 
a  typical ' '  typhoid  state. ' '  Why  ?  Because,  whether  the  mor- 
tality is  obviously  and  noticeably  decreased  or  not,  the  con- 
dition of  the  patient,  the  severity  of  the  attack,  and  the 
general  course  of  the  disease  are  inexpressibly  milder,  more 
manageable,  more  comfortable  under  the  bath  regime  than 
under  any  other  treatment  I  have  ever  seen,  and  I  have 
seen  the  other  in  all  its  horrors.  Let  us  assume  that  the 
bath  treatment  is  practicable  in  private  practice  with  any 
nurse  who  is  properly  trained.  It  is  practicable  with  any- 
body who  can  give  his  or  her  attention  to  it  faithfully. 

What  are  the  difficulties  in  private  practice?  I  will  be 
answered  by  fifty  physicians  here  to  this  effect  —  opposition 


MEDICINE      AND      I'  IJ  lU.  F  C      HEALTH  167 

on  the  i^'irt  of  the  people.  Is  that  a  good  reason?  Obvi- 
ously, if  the  treatment  of  typhoid  with  the  hath  is  dis- 
tinctly a  better  therapeutic  measure,  the  moral  obligation 
is  so  great  that  we  can  not  consider  it  as  a  cogent  reason. 
If  it  is  not  a  good  reason,  if  it  is  not  a  sufficient  reason,  then 
it  is  obviously  our  duty  to  do  the  very  best  we  can  for  our 
patients.  General  opi)osition  on  the  part  of  the  people 
does  not  exist.  It  exists  as  a  remonstrance,  as  a  surprise, 
as  a  reaction  to  an  innovation,  but  it  does  not  exist  as  an 
irresistible,  immovable  obstacle,  and  it  is  entirely  within 
the  scope  of  the  physician  to  go  in  and  master  the  situation, 
and  if  he  can  not  prevail,  to  withdraw. 

There  are  one  or  two  points  that  I  want  to  speak  about. 
In  the  early  baths,  when  the  patient  does  not  know  what  is 
going  to  happen,  you  had  better  not  talk  about  cold  tubs. 
The  early  bath  should  be  spoken  of  as  a  bath.  If  you  wish, 
give  the  patient  a  warm  bath.  Let  the  whole  process  be 
done  with  a  warm  bath  until  the  patient  gets  over  the 
newness  of  the  situation.  Let  the  first  bath  be,  for  instance, 
not  cooler  than  90° ;  the  next  one  reduced  to  80° ;  the  third 
one  to  75°,  or  to  the  point  3^ou  desire  it.  In  other  words 
display  a  little  sense,  and  there  will  be  no  difficulty  about  it. 

In  the  second  place,  the  earliness  with  which  the  typhoid 
regime  is  instituted  and  used  is  as  important  in  the  bath 
treatment  as  is  the  antitoxin  for  diphtheria.  It  is  here  we 
make  a  mistake.  We  wait  until  patients  are  very'-  ill  before 
w^e  give  the  tubs.  I  say  this  from  considerable  experience : 
Resort  to  the  use  of  the  tubs  early;  do  not  wait  for  a  diag- 
nosis, if  the  temperature  warrants  the  use  of  tubs.  If  the 
case  is  not  typhoid,  no  harm  is  done.  If  it  is  typhoid,  you 
have  doubled  and  quadrupled  your  therapeutic  effect. 

In  conclusion,  let  me  urge  that  we  meet  this  matter 
squarely.  Do  it  well  and  with  conviction  or  not  at  all. 
Man}"  nurses  are  not  trained  to  ' '  tub ' '  and  do  not  help  along, 
especially  with  an  objecting  family.  They  must  be  taught. 
Teach  them.     Many  physicians,  recognizing  the  trend  of 


l68  HENRY      BAIRD     FAVILL 

scientific  opinion,  make  show  of  using  tubs,  but  often  ineffi- 
ciently and  usually  too  late  to  secure  the  best  results.  These 
are  formal  rather  than  real  efforts.  If  the  thing  is  good 
we  ought  to  want  to  use  it  thoroughly.  If  it  is  practica- 
ble, there  is  no  excuse  not  to.  Why,  then,  is  it  not  general? 
Let  the  ten  per  cent  of  avoidable  mortality  continue  to 
demand.     Why? 


M  K  I)  I  C  I  N  F<:      AND      IMMU.  I  f!      H  IC  A  I.  T  H  169 


Delivered,  iMf'ly-lhird  Annual  Meclinj.^  of  the  Aincrican  Medical  Associa- 
tion in  the  .Section  (jn  I'ractiee  of  Mc(Hrine. 
Printed,  Journal  of  the  American  Medical  Association,  Nov.  15,  1902. 

VENESECTION 

I  WILL  not  a])ol()}^Mzc  for  occu]jying  your  attention  with 
a  topic  to  which  1  am  al)le  to  bring  neither  new  facts 
nor  sati.sfactory  conclusions.  My  excuse  is  the  impor- 
tance of  the  subject. 

You  will  agree  with  mc,  first,  that  there  has  been  dur- 
ing the  last  few  years  a  tendency  to  place  a  greater  value 
on  bleeding;  second,  that  the  indications  for  its  use  are 
vague  and  indefinite  as  now  defined  in  the  literature; 
and  you  may  agree,  third,  that  it  is  of  the  utmost  impor- 
tance that  this  procedure  of  recognized  value  be  not  again 
discredited  by  indiscriminate  employment  in  obviously 
inappropriate  conditions. 

Nowhere  can  one  glean  a  more  instructive  lesson  than 
in  following  the  steps  of  Trousseau  as  he  slowly  drew  away 
from  the  then  dominant  views  as  to  venesection,  sifting  out 
with  his  rare  judgment  the  real  from  the  apparent,  and  final- 
ly taking  a  stand  that  was  quite  out  of  harmony  with  his 
contemporaries.  It  is  noteworthy,  however,  that  his  reser- 
vations as  to  the  value  of  bleeding  were  in  general  centered 
on  two  aspects  of  the  subject:  The  antiphlogistic,  which 
he  did  not  subscribe  to;  and  the  pureh^  mechanical,  as,  for 
instance,  the  value  of  bleeding  to  check  or  remove  cerebral 
hemorrhage,  which  he  likewise  discredited.  Both  of  these 
reservations  he  fortified  by  convincing  experience,  not  only 
as  to  non-efficacy,  but  with  a  positive  opinion  that  patients 
so  treated  progressed  less  favorably  than  others.  It  is  not 
likely  that  on  these  aspects  of  the  matter  his  judgment 
will  be  found  faulty.  At  that  time,  however,  there  was 
hardly  considered  the  specific  relation  of  the  blood  vessel 
contents  and  the  inadequate  heart. 


I70  HENRY      BAIRD     FAVILL 

Time  has  developed  a  view  that  there  is  a  condition 
liable  to  occur  in  which  there  is,  for  various  reasons,  an 
incapacity  of  the  heart  to  dispose  of  the  blood  which  it  is 
called  on  to  circulate.  It  is  not  my  purpose  to  discuss 
that.  At  this  time  we  are  obliged  to  accept  it  as  a  working 
hypothesis. 

The  point  of  importance,  then,  is :  What  are  the  various 
conditions  under  which  this  heart  inadequacy  may  develope  ? 
and  out  of  that  inquiry,  what  of  these  are  in  any  degree 
amenable  to  correction  by  the  withdrawal  of  blood?  In 
many  cases  of  respiratory  embarrassment  in  which  asphyxia 
is  threatened,  it  is  difficult  to  form  a  judgment  as  to  the  most 
important  factor  in  the  embarrassment,  inasmuch  as  cardiac 
labor  is  associated  with  toxic  neuro- vascular  conditions  im- 
possible to  disentangle.  Occasionally  one  will  encounter  a 
situation  that  seems  reasonably  plain. 

Case  i.  A  man,  seventy-two  years  of  age,  robust, 
sturdy,  and  of  sound  organs,  so  far  as  careful  clinical  obser- 
vation by  myself  during  several  years  past  could  deter- 
mine, living  in  the  suburbs,  having  a  cold,  came  to  town 
without  an  overcoat,  took  a  Turkish  bath,  and  went  home 
chilled.  At  once  became  "stuffed  up"  and  rapidly  grew 
worse,  until  in  the  course  of  six  hours  I  saw  him  in  consul- 
tation in  the  following  condition: 

Cyanotic  breathing  approaching  stertorous,  very  rest- 
less, but  almost  comatose,  breathing  slowly  and  noisily. 
Lungs  filled  with  rales,  distributed  universally.  Heart 
sounds  inaudible,  partly  because  of  pulmonary  noise.  Heart 
dullness  decidedly  increased,  pulse  feeble,  irregular  and 
almost  vanishing.  My  statement  was:  "He  can  not  live 
two  hours."  I  obtained  permission  to  bleed;  withdrew 
950  c.c.  of  blood.  As  it  flowed,  the  patient  grew  quieter. 
Pulse  returned,  consciousness  returned,  turning  on  his  side 
slept  two  hours,  constantly  improved  in  his  respiration  and 
recovered.  At  this  date  he  is  exceptionally  sound  for  a 
man  of  that  age. 


M  E  D  I  C  I  N  IC      A  N  i:>      IMJ  B  L  I  C      II  K  A  F.  T  H  i  7  r 

I  cite  this  because  it  marks  a  type.  Having  a  set  of 
conditions,  due  to  accidental  circumstances,  which  condi- 
tions I  interpret  to  be  intense  pulmonary  engorgement, 
with  right  heart  distension,  in  an  individual  whose  organs 
are  essentially  sound,  and  an  exciting  cause,  transitory  in 
character,  there  can  be  little  question  that,  first,  in  such 
conditions  blood  letting  is  indicated;  second,  that  its  action 
is  strictly  mechanical,  removing  the  immediate  over-disten- 
sion, so  paralyzing  to  any  hollow  viscus. 

To  this  exact  type  few  cases  conform,  for  either  the 
organic  conditions  are  originally  degenerate,  or  the  exciting 
causes  are  not  transient,  being  much  more  likely  to  be 
infectious.  A  judgment  as  to  the  degree  of  approach  to 
these  conditions  is  important  as  a  basis  for  an  opinion 
as  to  the  probable  good  to  be  accomplished  by  bleeding. 
Unquestionably,  organs  not  too  degenerated  may  be  suc- 
cessfully relieved,  and  that  even  in  the  presence  of  contin- 
uing and  augmenting  excitants.  But,  generally  speaking, 
the  non-febrile,  or  perhaps  toxic  as  against  infectious,  con- 
ditions will  offer  more  opportunities  for  useful  interference. 

Despite  the  fact,  however,  that  these  optimum  condi- 
tions are  unusual,  their  rarity  has  more  relation  to  prog- 
nosis than  to  therapeutic  indications,  for,  beyond  doubt, 
there  are  conditions  demanding  relief  by  these  means 
which  have  little  in  common  with  the  case  cited,  yet  in 
which  the  immediate  danger  is  cessation  of  the  pulmonary 
circulation. 

Case  2.  A  man  of  fifty-four  years,  very  large,  strong, 
and  of  previous  bad  habits,  whose  recent  history,  though 
not  the  subject  of  medical  investigation,  should  be  inter- 
preted as  that  of  dilating  heart,  presumably  ^^-ith  marked 
degeneration. 

He  was  found  with  great  dyspnoea,  somewhat  cyanotic, 
capillary  circulation  very  bad,  pulse  rapid  and  feeble. 
Eight  hundred  c.c.  of  blood  withdra'\ATi  produced  at  once 
relief  to  breathing  and  general  distress  and  a  considerable 


172  HENRY     BAIRD     FAVILL 

improvement  in  venous  and  capillary  stasis,  but  no  material 
improvement  of  pulse  and  with  no  considerable  response 
to  a  repeated  venesection  or  to  other  treatment.  Patient 
died  after  a  period  of  two  days. 

This  case  serves  to  mark  the  contrast  between  two  indi- 
viduals whose  essential  difference  was  the  condition  of 
heart  muscle:  The  one  who  died,  relatively  young,  excep- 
tionally strong,  plethoric,  and  far  less  obviously  embar- 
rassed; the  one  who  survived,  old,  relatively  far  less  strong, 
and  not  plethoric,  and,  at  the  time  of  treatment,  with  disso- 
lution impending.  It  seems  to  me  plain  that,  from  the 
mechanical  side,  the  condition  of  the  heart  muscle  rather 
than  the  intensity  of  the  provoking  cause  will  determine 
the  issue. 

With  regard  to  exciting  factors  in  these  conditions,  one 
can  know  but  little.  "Taking  cold"  is  an  obvious  enough 
fact,  but  quite  inexplicable.  That  it  is  a  mixed  result  of 
toxic  influence  and  neurotic  response  seems  likely,  and  its 
varieties  will  show  the  preponderance  of  the  neurotic  factor 
at  one  time  and  the  toxic  or  infectious  factor  at  another. 
This  view  is  illustrated  by  cases  which  occur  under  circum- 
stances which  do  not  seem  to  be  causally  adequate. 

Case  3.  A  woman,  thirty-eight  years  of  age,  was 
brought  into  the  hospital  giving  a  history  of  several  days' 
sickness.  Her  condition  on  entrance  was  that  of  exagger- 
ated dyspnoea,  pronounced  cyanosis,  and  the  following 
physical  findings:  Respiration  audible  over  the  whole  of 
both  lungs,  showing  no  signs  of  consolidation,  but  with  the 
most  extreme  development  of  moist  rales  which  I  have  ever 
heard.  Expectoration  reasonably  free,  watery,  but  not 
bloody.  Pulse  130,  with  considerable  volume,  but  irregular. 
Area  of  heart  dullness  decidedly  increased  to  the  right, 
but  heart  tones  not  appreciably  altered. 

The  patient,  being  in  terrible  distress  and  with  increasing 
cyanosis,  was  bled  600  c.c,  she  being  rather  a  delicate  type 
of  woman.     The  symptomatic  relief  was  immediate,   the 


M  IC  I)  I  r  F  N  I-:      AND      IMMM.  IC      IM^AI.  TFI  173 

breathing  Ijcconiinj^^  cisier,  the  distress  abated,  and  some 
sleep  followed.  For  the  lime  the  pulse  was  markedly- 
improved,  both  as  to  rej^uiarity  and  rate.  The  pulmonary 
conditions,  however,  did  not  change  so  far  as  I  could  sec, 
and  the  patient  went  on,  and  in  the;  course  of  two  days 
died,  without,  however,  a  recurrence  of  the  intense  dyspnoea. 
There  was,  during  the  course  of  this  attack,  no  rise  of  tem- 
perature. The  cause  of  this  attack  was  quite  beyond  my 
discovery,  inasmuch  as  the  general  clinical  findings  were 
negative.  That  weakness  of  the  heart  itself  was  not  the 
precedent  cause,  is  rendered  probable  by  the  history  of 
previous  perfect  health. 

It  leads  one  to  suppose  that  some  acute  toxic  or  possibly 
infective  element  was  present  and  persistent.  It  indicates 
in  a  way  the  hopelessness  of  venesection  in  the  presence  of 
a  persistent  exciting  cause.  This  case  I  w^ould  distinguish 
as  not  of  the  class  of  angio-neurotic  edema,  of  which  I  have 
seen  a  few.  That  there  may  have  been,  how^ever,  some  deep' 
analogous  toxemia  is  quite  possible.  In  the  three  cases 
cited,  symptomatic  relief  was  afforded  b\^  the  withdrawal 
of  comparatively  large  quantities  of  blood.  All  the  cir- 
cumstances warrant  the  belief  that  mechanical  obstruction 
and  overpowering  of  the  right  heart  formed  the  essential 
difficulty.  The  question  arises,  w^hether  the  overpowering 
of  the  right  heart  is  necessarily  mechanical. 

Case  4.  A  man,  sixty  years  of  age,  robust,  of  reason- 
ably good  physique,  and  on  recent  observation  pronounced 
sound.  He  was  taken  with  pneumonia,  in  a  typical  way, 
developed  immediately  intense  pain,  and  in  the  course  of 
twenty  hours  profuse  watery  bloody  expectoration,  not 
rusty  nor  prune  juice,  but  bright  red.  The  intensity  of  this 
feature  was  very"  noticeable.  On  the  third  day,  while  signs 
of  hepatization  were  not  clear,  the  heart  appeared  to  become 
markedly^  embarrassed.  It  became  extremely  arhythmic, 
feeble,  and  rapid. 

The  suspicion  w^as  inevitable  that,  in  spite  of  the  previous 


174  HENRY      BAIRD     FAVILL 

opinion  based  on  recent  examination  by  myself  as  to  the 
soundness  of  the  heart,  the  heart  muscle  was  badly  degen- 
erated.    It  had  all  the  behavior  of  an  exhausted  heart. 

Although  there  was  some  divergence  of  opinion  among 
the  attendants,  most  of  whom  thought  that  the  behavior 
was  an  evidence  of  intense  toxemia,  it  was  nevertheless 
agreed  to  bleed,  on  the  hypothesis  that  the  weakened  muscle 
needed  relief  in  any  event.  Venesection  was  made  and  the 
relief  to  the  symptoms  was  noticeable  from  the  very  begin- 
ning of  the  flow.  So  very  marked  was  this  that,  when  the 
flow  was  obstructed  somewhat  obstinately  after  300  c.c. 
had  been  withdrawn,  it  was  deemed  advisable  to  let  the 
matter  rest  at  that  point,  inasmuch  as  a  fresh  venesection 
could  be  made  at  any  moment.  The  heart  became  regular, 
the  volume  fair,  and  the  pain  and  dyspnoea  distinctly  less. 
The  relief  in  this  matter  was  not  very  prolonged,  however, 
and  subsequent  venesections  were  done  with  the  same  relief 
each  time,  the  case  passing  on  at  the  end  of  a  week,  however, 
fatally. 

Throughout  this  experience,  with  the  brief  intervals 
represented  by  the  periods  of  relief  from  bleeding,  the  heart 
of  this  man  seemed  absolutely  untrustworthy,  basing  the 
judgment  on  the  character  of  the  pulse.  On  the  other 
hand,  with  heart  tones  reasonably  satisfactory,  there  was 
maintained  an  unusual  excretion  of  urine,  and,  in  the  early 
history,  of  exceedingly  good  quality. 

It  is  clear  that  the  cardiac  inadequacy  could  not  have 
been  as  great  as  appeared.  It  was,  however,  a  matter  of 
great  surprise  at  the  autopsy  to  find  that  the  gross  appear- 
ance of  the  heart  was  rather  noticeably  normal.  Not  only 
was  the  color  and  texture  of  the  muscle  good,  but  unusually 
firm  and  of  normal  thickness.  The  microscopic  showings 
indicated  certainly  no  greater  fibroid  change  than  is  usual 
at  that  age,  so  that  the  summing  up  of  the  heart  condition 
must  be  considered  as  very  far  from  degenerated. 

Two  facts  are  noticeable:     The  bad  action  of  the  heart 


M  E  D  T  r  T  N  E      AND      P  11  lil.lC      H  E  A  F.  T  Ff  17.^ 

at  the  outset  of  the  infection  when  the  minimum  of  lung 
was  involved,  and  second,  the  marked  improvement  of 
heart  action  under  the  withdrawal  of  a  minimum  quantity 
of  blood,  300  c.c. 

This  case  raises  the  questions:  First,  to  what  extent 
heart  embarrassment  may  be  toxic  rather  than  mechanical; 
second,  to  what  extent  under  such  intoxication,  otherwise 
minor  embarrassments  may  become  important;  third, 
whether  there  is  some  complicating  or  intermediate  factor 
operating  through  the  nerve  centers  which  indirectly  affects 
the  heart  capacity. 

I  am  aware  that  this  is  more  or  less  fruitless  speculation, 
yet  I  would  call  attention  to  two  facts  among  many  which 
possibly  bear  on  it.  First,  the  fact  that  the  same  symp- 
tomatic relief  as  to  the  pain  and  dyspnoea  sometimes  follows 
leeching  and  cupping,  which  manifestly  is  not  immediate 
relief  to  the  right  heart.  Second,  that  conditions  purely 
neurotic,  such  as  tetany,  are  by  old  writers  considered  as 
susceptible  of  symptomatic  relief  by  bleeding. 

I  am  unable  to  put  these  reflections  into  any  more 
tangible  form,  but  the  question  is  always  in  my  mind,  to 
what  extent  an  indirect  influence  is  involved  in  this  question 
of  bleeding. 

I  omit  detail  of  a  number  of  venesections  in  more  ordi- 
nary conditions,  namely,  advanced  pneumonia  and  cardiac 
embarrassment,  all  terminating  fatalh'.  The  preceding 
cases  are  all  unusual  in  some  respect.  The  point  interesting 
to  me  is,  from  these  as  a  text.  Do  we  gain  any  idea  as  to 
indications?  The  fact  of  fatal  issue  does  not  at  all  bear 
on  the  case,  for  in  the  nature  of  things  the  majority  of 
patients  so  treated  will  die.  What  we  want  is  a  method 
of  reasoning  that  will  reduce  the  useless  bleedings  to  a 
minimum,  and  still  insure  the  relief  where  bleeding  would 
serve  a  useful  purpose.  Let  us  postulate,  then,  that  when- 
ever we  encounter  great  pulmonary  embarrassment  due  to 
vascular   engorgement,    bleeding  is   suggested.     ^Vhat   are 


176  HENRY     BAIRD      FAVILL 

the  determining  considerations?  Ought  we  not  to  ask,  first, 
Is  the  engorgement  irritant,  that  is,  toxic,  or  is  it  due  to 
stasis?  The  conditions  at  the  outset  of  pneumonia  are  irri- 
tant, at  the  close  due  to  stasis,  that  is,  paralytic.  If  we 
bleed  early,  it  is  as  a  prophylactic;  essentially  as  an  anti- 
phlogistic measure,  but  with  an  eye  to  the  heart  struggle 
later.  If  we  bleed  late,  it  is  to  assuage  the  struggle  already 
taking  place. 

The  experience  in  Case  No.  4,  pneumonia  with  bad 
heart  action  from  the  first,  relieved  repeatedly  by  small 
bleedings,  raises  the  question  whether  there  are  not  condi- 
tions in  which  repeated  small  bleedings  are  useful.  Cer- 
tainly neither  primary  nor  terminal  bleeding  has  given 
much  encouragement  thus  far.  Ought  we  not  to  ask, 
second.  Is  the  toxic  cause  to  be  considered  as  transient 
or  increasing? 

In  response  to  the  query,  Which  will  be  classed  as 
increasing?  if  we  reply,  Pneumonia  and  other  acute  in- 
fections, it  will  tend  to  rule  out  venesection  as  a  rule, 
providing  we  feel  that  a  progressive  cause  is  a  bar  to  its 
usefulness. 

Unless  we  believe  in  real  antiphlogistic  effects,  which 
I  fancy  we  do  not,  free  early  bleeding  seems  to  me  to  be 
of  doubtful  utility.  The  rare  condition  of  extreme  plethora 
might  justify  it,  but  plethora  is  not,  as  a  rule,  intravascular 
excess,  but  the  blood  tension  is  in  part  a  general  condition 
which  is  likely  to  be  speedily  reproduced  from  the  tissue 
conditions,  and,  on  the  other  hand,  the  cardiac  exhaustions 
are  not  at  all  confined  to  the  plethoric,  but  bear  close  rela- 
tion to  the  toxemia  and  vital  resistance. 

If  it  can  be  assumed  that  the  toxic  or  excitant  cause  is 
not  progressive,  at  once  we  reach  the  third  question :  What 
is  the  condition  of  the  heart  muscle?  Instances  where  it  is 
good  and  known  to  be  good,  as  in  Case  i,  are  rare,  but  fur- 
nish a  clear  indication.  Cases  where  it  is  unknown  but  pre- 
sumably bad,  as  in  Case  2,  furnish  a  doubtful  justification. 


M  F,  D  T  r  T  N  E      AND      IMM',  l.f(        HI-;  A  I,  [If  [77 

Condition.s  that  are  reasonably  to  be  considered  as  not 
degenerate,  as  in  Case  3,  the  woman  with  edema  and  no 
general  lesion,  furnish  good  indication. 

However,  most  of  the  instances  of  acute  right  heart 
embarrassment  occur  in  individuals  whose  cardiovascular 
conditions  are  chronically  deteriorating.  The  indication  is 
clear  enough  where  suffocation  is  threatened,  but  the  prog- 
nosis is  bad. 

Time  will  not  permit  me  to  go  farther  into  detail. 
There  always  arises  the  question,  Will  it  do  harm  to  bleed? 
The  answer  is,  Rarely,  under  conditions  that  at  this  day 
would  be  at  all  considered.  Even  the  theoretical  contra- 
indications of  some  authors  I  believe  to  be  largely  fanciful, 
and  the  few  instances  of  disaster  that  followed  letting  of 
even  a  very  small  amount  of  blood  may  be  disregarded. 
In  spite  of  the  fact,  however,  I  believe  that  we  should  move 
in  the  matter  with  the  utmost  discrimination;  not  so  much 
that  we  may  endanger  the  individuals,  but  lest  we  discredit 
a  therapeutic  measure  that  is  slowly  advancing  to  its  true 
status. 


178  HENRY      BAIRD     FA  V  ILL 


Delivered,  University  of  Chicago,  June,  1905. 

AM   I   MY   BROTHER'S   KEEPER? 

IF  there  is  one  idea  more  than  another  characteristic  of 
to-day's  civiHzation,  it  is  the  conviction  that  in  the 
abstract  and  in  general  a  man  is  his  brother's  keeper. 

Side  by  side  with  the  development  of  the  concept  of 
individual  responsibility  grows  the  principle  of  common 
oversight.  While  the  belief  in  individual  liberty  becomes 
more  deeply  rooted,  the  principle  of  reciprocal  rights  and 
obligations  limiting  and  qualifying  personal  freedom  is 
established. 

According  to  our  relation  to  an  issue,  we  assert  or  admit 
the  rights  of  society  to  define  the  limitations  upon  indi- 
vidual acts,  but  under  the  fundamental  reservation  that  the 
restriction  be  for  the  benefit  of  another.  Direct  control 
of  the  individual  for  his  own  good  is  not  at  all  an  accepted 
doctrine,  and  only  exceptionally  a  fact,  as  some  manner 
of  police  power. 

We  educate  children  by  law  because  the  unprotected 
adult  is  a  drag  upon  society.  We  vaccinate  the  suscep- 
tible for  the  same  reason  that  we  wreck  a  building  in  the 
path  of  a  conflagration,  to  break  the  path  of  conduction 
and  diminish  the  material  for  feeding  a  scourge,  thereby 
protecting  contingent  interests.  But  the  good  to  the 
individual,  if  any,  is  incidental  and  not  essential,  and  under 
rare  conditions  harm  to  the  individual  is  held  to  be  justi- 
fied by  the  common  need.  Whereas,  with  more  or  less 
grace,  we  subscribe  to  this  adjustment  of  interests  upon  the 
basis  stated,  we  rebel  furiously  at  the  suggestion  of  control 
for  individual  or  even  class  benefit. 

We  accept  the  State  control  of  questionable  commodities 
for  public  protection,  and  absolutely  repudiate  the  sugges- 
tion of  dictation  to  us  as  individuals  in  the  use  of  them. 
We  accept  and  applaud  the  law  securing  to  the  inhabitants 


MEDIC  INK      AND      IMJIM.  [C      H  !•;  A  f.  T  If  179 

of  a  tenement  adcciuate  spaec  for  air,  and  uUcrly  rlecline 
to  be  forced  to  have  it  fresh. 

This  distinction  as  to  motive  and  object,  as  to  ostensible 
beneficiary  in  pubHc  intervention  in  aflfairs  more  or  less 
private,  is  as  broad  as  the  world  of  moral  discrimination. 
It  is  not  an  academic  question.  It  is  an  expression  of  the 
deepest  ethical  principle.  It  embodies  the  conception  of 
duty,  under  moral  inspiration  of  privilege,  in  circumscribing 
one's  activities  or  forces  to  further  the  common  good.  But, 
it  also  unyieldingly  adheres  to  the  dogma  that  one's  per- 
sonal evolution  is  his  most  sacred  trust.  What  is,  therefore, 
upon  one  face  a  question  of  material  interest,  is,  upon  the 
other,  one  of  moral  existence,  and  the  interpretation  of 
rights  under  a  somewhat  wavering  illumination  is  the  chief 
problem  of  civic  organization. 

Obvious  public  necessity  is  well  established  as  a  para- 
mount consideration,  and  the  difficulties  are  chiefly  prac- 
tical; but  private  benefit  as  a  basis  of  social  enactment  is, 
as  a  voluntary  matter,  regarded  as  demoralizing,  and  as  a 
compulsory  matter,  outrageous. 

At  no  point  are  the  difficulties  to  be  encountered  greater 
than  in  the  questions  of  public  health.  At  no  point  is 
interference  more  resented  by  the  ignorant,  or  more  tol- 
erated by  the  enlightened.  It  is  an  almost  infallible  line 
of  cleavage  between  intelligence  and  prejudice,  and  it  follows 
that  the  obstacles,  being  inversely  as  the  intelligence,  are 
almost  insurmountable. 

Up  to  a  given  point  the  principle  of  public  weal  is  suffi- 
cient, and  public  acquiescence  is  practically  cooperation. 
Beyond  this  point,  however,  the  necessity  to  obey  merges 
into  the  purely  voluntary,  and  the  will  to  do  being  abso- 
lutely dependent  upon  comprehension,  we  find  a  check  in 
the  advance  of  any  sanitary  movement  so  abrupt  as  to 
make  confusion  and  even  retrogression  inevitable. 

The  consequence  is,  that  sanitary  science  is  in  the 
position  of  utmost  importance  and  influence  in  a  definite 


i8o  HENRY      BAIRD     FAVILL 

territory  and  impotent  in  the  adjoining  fields  where  He  its 
logical  fruits. 

It  is  trite  to  say  that  civilization  is  an  artifact,  which, 
up  to  even  the  present  day,  has  grown  with  little  plan  and 
with  but  indefinite  purpose.  Side  by  side  have  been  oper- 
ating processes  both  favoring  and  antagonistic  to  human 
advancement. 

It  is  a  fact  of  great  importance  that  average  duration 
of  life,  and  more  notably  still,  the  decrease  of  mortality  in 
certain  periods  of  life,  have  been  the  result  of  the  condition 
of  civilization.  It  is  a  grave  fallacy  to  assume,  however, 
that  the  achievement  is  of  necessity  an  advance,  or  that  it 
is  immixed  with  the  elements  of  gravest  peril.  Natural 
selection  in  its  ordinary  sense  is  strongly  modified  and 
largely  in  abeyance,  and  in  its  stead  is  a  selection  of  bewil- 
dering complexity.  Infant  mortality,  to  us  a  spur  to  our 
best  endeavor  in  preventive  medicine,  is  perhaps  the  most 
essential  factor  in  race  protection.  Piteous  as  is  the  picture 
of  the  perishing  weak,  the  dependence  of  the  race  upon  that 
elimination  is  obvious.  It  is  hardly  safe  to  qualify  this 
statement  by  saying,   "under  natural  conditions." 

What  guarantee  have  we  that,  with  all  the  resources 
of  civilized  conditions,  we  can  neutralize  the  stream  of 
viciousness,  tiny  though  it  be,  that  is  left  in  by  modern 
intervention  in  the  selective  process? 

We  imply,  in  the  contention  that  there  is  such  a  guar- 
antee, that  society  has  a  means  to  use,  adequate  to  meet 
this  situation  and  justifying  the  process. 

If  so,  what  is  it,  and  is  it  in  efficient  operation? 

If  the  great  mass  of  infant  lives  saved  by  sanitary  con- 
trol were  those  of  the  intrinsically  weak  and  defective,  it 
is  doubtful  if  the  damage  of  preserving  them  could  in  any 
way  be  offset.  If  it  were  possible  to  preserve,  up  to  matur- 
ity, the  majority  of  the  physically  vicious,  it  is  certain  that 
the  mark  would  be  indelible.  Fortunately  neither  of  these 
propositions  portrays  the  facts. 


medic:  I  NIC      A  N  F)      I'  H  lU,  I  f      FII<:AF.TH  iSi 

Although  it  is  donhlJcss  true,  that  the  physically  non- 
resistant  arc  especially  the  victims  of  so-called  preventable 
disease,  and  hence  under  conditions  undisturbed  by  modern 
ways  furnishing  the  great  majority  of  deaths,  it  is  also  true 
that  the  manner  of  life  to-day  brings  into  the  vulnerable 
class  practically  all  infants. 

It  follows  that  the  natural  elimination  under  our  condi- 
tions so  unnatural  would  remove  the  weak  and  strong  and 
more  than  balance  its  salutary  influence  by  this  destruction. 

We  have  no  reason  to  believe  the  robust  child  to  be 
greatly  superior  to  the  feeble  in  resisting  infections.  The 
problem  of  resistance  to  infection  is  too  deep  and  extensive 
for  this  discussion. 

In  that  respect  the  question,  Who  are  the  "fit"? 
would  find  its  answer  in  surprising  terms.  However  we 
may  finally  define  the  term,  the  practical  battle  with  these 
destructive  forces  results  in  an  enormous  preservation  of 
life,  and  to  a  large  extent  saves  the  weak  with  the  strong. 
In  protecting  our  best  against  overpowering  attack,  we  also 
preserve  our  worst  to  be  a  subsequent  problem. 

Please  bear  in  mind  that  in  this  connection  I  am  speak- 
ing only  of  physical  characteristics.  Aside  from  the  matter 
of  infection,  however,  there  are  influences  of  great  moment 
operating  to  equalize  the  ability  to  withstand  the  experience 
of  life.  Generally  speaking,  the  hardships  and  vicissitudes  of 
life  are  so  modified  as  to  remove  the  tax  upon  physiologic 
resistance  to  a  degree  very  debilitating  to  the  mass,  while 
actually  a  salvation  to  the  few.  We  are  in  an  age  of  com- 
fort and  in  circumstances  of  relative  prosperity,  and  the 
evidence  of  it  is  not  all  aesthetic. 

The  same  conditions  of  resource  and  opinion  that  make 
it  possible  to  shield  and  succor  the  weak,  lead  to  pampering 
and  protecting  the  strong,  to  the  end  that  natural  accom- 
modation to  vicissitudes  and  the  physiologic  stimulus  that 
determines  the  adaptation  are  impaired. 

This  is   by   no   means   confined   to   the   well-to-do  nor 


i82  HENRY      BAIRD     FAVILL 

conceived  in  the  notion  of  luxury.  Protection  from  the 
elements  does  not  at  all  imply  care  or  safety  except  in 
limited  directions. 

The  babes  in  a  tenement  of  the  most  unwholesome  type 
may  be  protected  from  the  greatest  menace  of  childhood, 
undue  exposure  to  cold  and  infected  milk.  The  result  on 
the  one  hand  is  life  saving,  even  as  to  the  very  feeble,  and 
upon  the  other  deplorable  as  to  all  developmental  con- 
siderations. The  factors  of  growth  and  ripening,  of  per- 
fecting— bone  and  tissue  —  blood  and  function,  are  almost 
utterly  ignored,  and  still  our  obligation  is  before  us. 

Thousands  of  children  are  saved  from  death,  which  would 
overtake  them  in  their  surroundings,  by  sanitary  inter- 
vention of  various  kinds.  They  are  carried  past  the  most 
vulnerable  period,  and  become  at  an  early  age  compara- 
tively resistant,  and  have  practically  survived  to  be  a  part 
of  the  community  that  is  perpetuating  itself,  and  what 
has  the  community  gained  thereby? 

Has  it  gained  more  than  numerical  strength,  and  is 
numerical  strength  a  desideratum?  Is  it  distinctly  desir- 
able that  the  earth  be  populated  at  all  hazard  as  rapidly 
as  possible?  Are  the  lives  that  are  perpetuated  an  element 
of  strength  and  progress  to  the  world?  Do  we  realize  that 
in  bringing  to  maturity  a  given  number  of  individuals  we 
are  also  making  it  possible  to  pass  on  through  procreation 
all  their  characteristics?  Have  we  confidence  in  the  power 
of  nature  to  breed  out  weakness  and  viciousness,  under  the 
conditions  that  are  imposed?  Are  we  not  certain  that 
mental,  moral,  and  physical  defect  are  bred  on  and  on,  and 
hence  that  for  every  infant  life  saved  to  an  individual 
essentially  defective,  society  must  pay  an  immeasurable 
penalty  ? 

To  all  of  these  queries  there  are  answers ;  to  all  the  argu- 
ments implied  in  them,  there  are  more  or  less  adequate 
replies.  Whether  the  world  gains  more  than  mere  num- 
bers in  this  process  depends  on  circumstances.     Equally  it 


MEDICINK      A  N  F)      P  U  H  F.  F  C      FF  F-:  A  F,  F   IF  183 

depends  upon  circumstances  how  vigorously  it  is  desirable 
that  the  earth  1)C  peopled.  But  the  genius  of  civilization 
does  not  approach  this  problem  in  that  way.  It  makes  a 
sweeping  assumption.  It  declares  that  life  and  the  right 
to  live  are  incontestable  and  inviolable. 

Under  the  influence  of  ethical  progress,  it  follows  that 
the  highest  duty  that  society  has  is  to  protect  the  lives  of 
the  defenseless,  and  it  is  u])on  infant  life  that  the  most  sig- 
nal and  systematic  effort  has  been  expended.  That  there 
is  a  tremendous  force  to  be  reckoned  with,  exactly  in  pro- 
portion to  the  success  of  the  efforts  to  preserve  infant  lives, 
is  too  obvious  for  discussion. 

The  world  learns  slowly  and  reluctantly:  That  there  is 
k  penalty  to  pay  for  every  interference  with  natural  law. 
That  the  evolution  of  conditions  is  the  massive  movement 
of  innumerable  factors.  That  the  individual  groups  in  this 
mass  are  composed  of  antagonistic  elements,  whose  powers 
for  advance  and  restraint  are  not  quite,  but  almost,  bal- 
anced. That  the  fraction  of  superiority  possessed  by  one 
factor  over  another  determines  the  course,  and  hence  that 
to  introduce  a  strong  and  decisive  force  is  to  establish  a 
train  of  consequences  that  must  be  met. 

In  the  most  unintentional  and  normal  ways  we  have 
offended  and  are  paying  the  penalties  and  struggling  fran- 
tically to  undo  the  mischief.  The  debt  due  to  ruthless 
destruction  of  the  forests,  under  the  idea  of  progress,  be  it 
remembered,  cannot  be  paid  in  centuries. 

The  hare  was  introduced  into  Australia  for  economic 
reasons  as  a  food  supply.  It  has  become  as  great  a  problem 
from  the  standpoint  of  a  pest  as  that  country  has  to  face. 

Strange  as  is  the  experience  of  Java,  it  is  more  enlight- 
ening than  absurd.  The  mongoose  was  introduced  as  an 
enemy  to  rats  and  mice.  In  consequence  the  mongoose,  un- 
checked in  its  increase  is  apparently  an  unsolvable  prob- 
lem, while  it  is  said  that  rats  and  mice  have  become  arboreal 
animals. 


i84  HENRY     BAIRD     FAVILL 

This  grotesque  dilemma  is  most  suggestive,  and  it  is  a 
gross  but  unmistakable  illustration  of  the  fact  that  for 
every  disturbance  of  natural  forces  there  is  a  compensation 
that  must  be  accepted. 

Would  one  annihilate,  if  he  might,  the  rats,  the  bearers 
of  bubonic  plague,  and  if  so,  what  price  would  he  pay? 

Science  is  recognizing  this  great  fact  of  compensation, 
and  this  problem  before  the  medical  world  is  coextensive 
with  medical  activities.  In  all  directions  we  are  able  to 
initiate  movements  and  direct  forces  far  beyond  our  grasp 
as  to  their  correlations.  We  project  a  line  and  pursue  it 
tenaciously,  to  a  great  extent  ignoring  its  related  neces- 
sities. We  attain  the  limit  for  express  trains,  and  have  not 
crossed  the  threshold  of  safety  considerations.  We  accum- 
ulate wisdom  by  experience  and  pay  the  enormous  price. 

Temerity  in  the  securing  of  startling  effects  is  as  char- 
acteristic of  medicine  as  of  railroading,  and  the  sense  of 
responsibility  as  to  ultimate  results  is  scarcely  as  great. 

So  it  is  true  in  a  sense  that  the  saving  clause  in  this  impli- 
cation, as  to  the  woe  of  preventive  medicine,  is  the  fact  that 
it  is  as  yet  inefficient. 

All  of  this  sort  of  "calamity  howl "  would  come  with  bad 
grace  if  it  were  to  stop  with  a  mere  criticism  of  the  results 
of  the  very  finest  efforts  of  humanitarians.  In  fact,  it  is 
not  even  a  criticism  nor  a  reservation,  but  a  reflection  upon 
the  long  series  of  problems  that  stretch  ahead  of  us  as  pros- 
pectors for  human  advancement. 

What  to  do  with  the  individuals  snatched  from  natural 
destruction  that  they  may  not  be  a  damage  to  the  race, 
is  not  a  greater  problem  than  what  to  do  with  the  race  which 
drifts  rather  than  travels  to  its  destination. 

The  feeble  and  defective  minority,  that  is  so  obvious 
an  object  of  woe  and  solicitude,  is  not  in  fact  materially 
more  so  than  the  more  normal  majority,  and  practically 
is  in  some  respects  less  a  puzzle. 

The  feeble,  the  technically  "unfit,"  serve  us  to-day  as 


M  IC  I)  I  (•  I  N  l<:      A  N  f)      IMIIM,F(       11  I-:  A  I.  I   H  1H5 

a  text,  as  an  example  of  necessary  foresight  that  no  one 
would  deny,  but  if  I  am  not  mistaken,  it  is  in  reality  more 
a  text  than  the  embodiment  of  distinctive  viciousness. 

While  it  is  true  that  the  vast  majority  of  human  beings 
are  of  the  class  of  workers  whose  bread  depends  upon  toil, 
in  modern  conditions  it  is  no  longer  true  that  toil  and  the 
sweat  of  the  lorow  are  synonymous. 

When  we  contrast  the  methods  of  labor  to-day,  with  the 
primitive  way  of  natural  man,  we  see  three  facts  clearly — 
first,  that  human  intelligence  has  increased  the  produc- 
tivity of  the  individual  to  a  fabulous  extent;  second,  that 
the  benefit  thereof  is  chiefly  in  the  line  of  aggregate  and 
accumulated  product;  and  third,  that  the  individual  pro- 
ducer is  not  onl}^  not  proportionally  better  off,  but  is  by 
reason  of  the  changes  of  method  liable  to  be  inexpressibly 
worse  off  in  his  actual  physical  relations. 

It  is  to  this  third  phase  that  this  discussion  must  be 
confined.  It  needs  but  a  word  of  reference  to  point  the 
difference  between  the  original  tiller  of  the  soil,  the  herder 
of  flocks,  or  the  worker  in  the  simple  arts,  and  their  modern 
successors. 

While  one  might  compare  favorably  the  essential  life 
of  the  agriculturist  of  to-day  with  that  of  the  past,  so  far 
as  conditions  of  labor  are  concerned,  yet  in  many  of  the  ways 
of  life  the  vices  of  civilization  are  as  rife  there  as  elsewhere. 

But  when  one  comes  to  compare  artisans,  the  contrast 
is  frightful.  From  the  basement  sweatshop  fashioners  of 
garments,  up  to  the  top-story  factory  child-laborers,  and 
down  to  the  sun-starved  workers  of  the  mines,  we  behold 
a  continuous  picture  of  "magnificent  achievement"  from 
the  standpoint  of  national  or  racial  wealth,  the  price  of 
which  is  what?  Human  lives?  Yes,  more  or  less,  but  if 
that  were  all,  it  would  be  fortunate  as  compared  with  the 
full  price. 

Human  manners  and  morals  —  thoughts  and  aspirations 
— sympathies  and  standards  —  all  are  in  the  balance  and 


l86  HENRY      BAIRD     FA  V  ILL 

under  the  dominance  of  burdened  and  smothered,  tainted 
and  poisoned  body  machiner^^  and  function.  The  trend  is 
toward  degeneracy. 

"The  sweat  of  his  brow"  has  a  meaning  greater  than 
mere  toil  and  fatigue  and  numb  submission.  "Joy  in  his 
work"  is  the  term  that  stands  to  man's  spiritual  hygiene 
as  figurative  brow-sweat  stands  to  his  physical  needs. 

But  would  you  remind  me  that  I  limited  myself  to  the 
discussion  of  physical  ills?  So  might  I,  and  in  the  discus- 
sion logically  pertinent,  touch  every  mental  and  moral  sore 
in  society.  Mental,  moral,  and  physical.  Which  is  para- 
mount ? 

The  integrity  of  man  will  not  permit  us  to  separate  into 
forces  acting  alone  the  influences  of  his  life.  So  interactive 
are  these  factors  that  one  may  take  any  of  them  as  the 
initial  term  and  work  out  a  scheme  of  sequence  and  depend- 
ence. 

Whether  as  a  positive  fact  sound  health  strongly  predis- 
poses to  mental  and  moral  sanity,  it  is  beyond  question 
that  as  a  negative  influence  ill  health  is  indescribably 
effective.  To  be  spiritually  clear  in  the  presence  of  bad 
physical  condition  is  only  vouchsafed  to  the  few  uplifted. 
"Mens  Sana  in  cor  pore  sano"  is  more  than  ideal.  It  points 
to  a  necessary  relation. 

Those  of  us  who  do  not  know  by  contact  the  facts,  are 
apt  to  picture  the  laboring  masses  as  strong  and  healthy, 
tough  and  resistant.  The  ideal  worker  is  all  that,  but  to- 
day the  laborer  who  approaches  that  is  either  of  the  fortu- 
nate group  whose  conditions  of  toil  are  such  as  to  permit 
such  development,  or  of  those  who  by  primary  endowment 
are  able  to  thrive  in  spite  of  deadly  conditions.  But  the 
multitude  who,  by  reason  of  impossible  conditions  of  work 
and  abode,  are  crawling  through  life  rather  than  walking, 
we  only  roughly  realize,  and  the  import  of  their  condition 
almost  escapes  us. 

How  the  race  as  a  whole  is  to  advance  when  it  meets 


M  TCI)  re  IN  I-:      AND      I'  CI'.  Lie     TIICAI.TIF  187 

SO  many  factors  of  retrogression  is,  of  course,  a  problem  in 
proportion,  'i'hat  the  element  making  toward  degeneracy 
be  made  a  safe  minority,  is  obviously  the  only  answer. 

When  we  come  to  the  practical  struggle  with  the  physical 
problems  involved  in  the  foregoing,  we  find  two  difficulties, 
either  of  which  seems  at  first  sight  insuperable. 

Lack  of  opportunity  —  lack  of  intelligence.  Industrial 
conditions,  the  great  battleground  of  to-day,  will  be  bound 
to  yield  to  the  demand  for  betterment  in  almost  all  respects 
before  any  direct  recognition  of  the  physical  needs  of  indi- 
viduals is  prominent. 

To  be  sure,  the  advance  made  by  the  working  class  in 
the  way  of  economic  betterments  does  tend  to  greater 
opportunity,  and  in  fact  the  soundest  footing  there  is,  for 
agitation  of  labor  questions,  is  the  effort  to  establish  condi- 
tions that  will  give  more  latitude,  more  elasticity.  It  is 
imperative  that  all  the  time,  all  the  strength,  all  the  courage 
of  men  and  women  shall  not  go  into  the  heartbreaking  strug- 
gle for  bare  existence.  Just  now,  for  the  most  part,  that  is 
the  case.  The  margin  between  non-dependence  —  I  can  not 
say  independence  —  and  pauperism  is  no  wider  than  the 
day's  work,  and  the  day's  work  is  the  limit  of  capacity. 

Recognition  of  this  necessity  is,  of  course,  gaining  ground 
rapidly,  and  the  efforts  at  solution  are  embodied  in  all 
phases  of  labor  strife,  legislation  and  philanthropy.  But 
it  is  only  in  the  rarest  instances  that  the  gains  in  oppor- 
tunity—  the  more  elastic  conditions  of  life  —  are  turned 
to  their  intelligent  ends.  Perhaps  we  could  regard  with 
more  respect  the  arbitrary  designation  of  what  are  a  day's 
work  and  pay,  if  there  were  any  assurance  that  the  free- 
dom secured  were  of  material  benefit.  But  patience  is  the 
watchword,  and  freedom  the  battle-cry.  Opportunity  must 
come  first,  and  industrial  freedom,  and  after  that  a  wider 
disposition  of  resources. 

Especially  is  this  true  as  related  to  the  second  great 
obstacle,  the  lack  of  intelligence. 


l88  HENRY      B  A  I  R  D     F  A  V  I  L  L 

Practical  knowledge  is  a  matter  of  education  of  some 
sort  and  from  some  source.  The  line  of  least  resistance  is 
the  rut.  It  does  not  matter  how  deep  or  how  crooked,  it 
is  easier  to  stay  in  than  climb  out.  It  takes  time  and 
strength  and  initiative  to  improve.  Who  of  us,  in  material 
ways  the  more  favored,  does  not  realize  the  difficulty  of 
gaining  intelligence?  Who  of  us  in  full  days'  employment 
has  time  to  lay  out  and  pursue  new  methods? 

The  State  says  to  the  laborers,  "Your  children  shall 
not  work  before  such  an  age,"  because  the  State  can  not  be 
burdened  with  individuals  who  are  "spent." 

The  immediate  effect  of  that  restriction  is,  upon  the 
family  economy,  a  measure  of  hardship,  and  it  is  only  the 
more  intelligent  who  welcome  the  law  for  its  ulterior  benefit. 
They  have  no  time  to  spare,  no  margin  in  food,  perhaps 
no  hope. 

The  physiologist  realizes  that  the  food  supply  of  the 
world  is  being  wasted;  that  lack  of  knowledge  in  handling 
materials,  mistaken  ideas  of  physical  necessity,  habitual 
demands  of  no  essential  importance,  make  the  food  problem 
the  great  burden  of  the  laboring  world.  Yet  what  time  and 
contact  have  these  same  laborers  to  learn  a  better  way? 
Shall  our  people  learn  it  by  the  screwing  down  of  the  supply, 
lower  and  lower,  by  the  increase  of  population  as  has  come 
to  pass  in  the  Orient,  or  shall  they  have  it  by  the  dissemi- 
nation and  application  of  knowledge? 

The  hygienist  sees  the  deadly  pull  upon  the  community 
of  filth  and  crowded  abodes.  He  can  see  pestilence  the 
outcome  of  one;  the  melting  down  of  hordes  of  valuable 
lives  by  insidious  disease,  the  result  of  the  other.  Of  what 
use  is  his  most  clear  and  authoritative  dictum,  even  if  it  be 
accepted,  unaided  by  other  forces?  For  cleanliness  and 
fresh  air  are  costly;  so  costly  that  only  by  the  wisest  coop- 
eration of  public  and  private  effort  are  they  practicable. 

Again  and  again  progress  is  stayed  by  lack  of  cooper- 
ation on  the  part  of  the  individual.     He  will  not  be  made 


MEDICINE      AND     P  U  M  I,  I  r      III-.  A  I.  Ill  189 

to  conform  anfl  lie  has  no  time  nor  way  to  learn  to  want 
to  conform. 

So  preventive  medicine  lays  its  most  sagacious  plan; 
public  health  .service  institutes  its  salutary  enactment;  and 
it  all  fails  in  a  measure  of  its  legitimate  success,  to  a  large 
extent  because  the  people  cannot,  for  one  reason  or  another, 
grasp  the  opportunity. 

Although,  under  our  own  observation,  jniblic  health 
matters  are  fragmentary  and  irregular  and  not  by  any 
means  what  they  might  be,  yet  there  is  a  well  defined  trend 
toward  intelligent  intervention  in  behalf  of  the  community. 

That  much  can  be  accomplished,  is  beyond  question. 
We  have  but  to  take  the  lesson  offered  by  the  Japanese  in 
the  present  war,  and  if  it  needs  emphasis  contrast  it  with 
our  own  record  in  the  Spanish  War,  to  see  that  brains  have 
to  do  with  mixing  even  these  colors. 

It  may  seem  a  contradiction,  but  it  is  in  fact  more  possi- 
ble to  have  a  sanitary  camp,  in  spite  of  all  its  difficulties, 
than  a  sanitary  city.  The  wisest  and  most  authoritative 
of  governmental  regulation  has  not  succeeded  in  carr>'ing 
health  into  the  crowded  urban  communities. 

The  reasons  are  many,  but  the  foregoing  considerations 
are  quite  enough  to  account  for  it. 

In  the  nature  of  things  it  is  not  to  be  hoped  that  the 
problem  of  bodily  health,  and  all  that  it  is  contingent  upon, 
is  destined  to  be  solved  by  approaching  it  in  the  aggregate. 
It  is  distinctly  and  unchangeably  an  individual  question. 
All  that  sanitary  control  can  do  now  or  ever,  so  far  as  our 
present  light  shows,  is  to  remove  or  avoid  overpowering 
obstacles  to  personal  development. 

And  now  I  face  the  query,  an  embarrassing  question 
from  a  didactic  standpoint:     What  is  the  way  to  health? 

Fortunately  I  have  no  theory  to  expound,  to  draw  upon 
myself  and  it  the  attack  of  all  those  with  similar  theories. 
I  am  going  to  ask  at  the  outset  what  we  shall  mean  by 
Health. ^    As  we  are  in  the  habit  of  discussing  these  topics, 


ipo  HENRY     B  A  I  R  D     F  A  V  I  L  L 

we  are  prone  to  confuse  several  ideas.  We  are  likely  to 
compare  with  one  another  unlike  types,  temperaments, 
stages  of  development,  and  above  all,  those  whose  life 
functions  are  not  comparable. 

Perfect  health  probably  does  not  exist,  and  our  stand- 
ards are  of  necessity  relative.  We  argue  at  one  time  from 
the  standpoint  of  muscular  power,  another  speed,  another 
constitution,  another  form,  and  usually  settle  down  for  a 
final  test  upon  longevity,  too  retrospective  to  be  a  fully 
satisfactory  criterion  for  personal  use. 

So  the  thoughtful  world  is  full  of  formulse  for  health, 
covering,  in  one  way  or  another,  food,  work,  sleep,  play, 
exercise,  mental  poise,  moral  control,  and  so  on  to  an  exag- 
gerated development  of  systems. 

Naturally  the  system  has  but  a  general  bearing;  cannot 
particularize  except  as  the  case  arises.  So  we  find  at  one 
period  muscle  building  to  be  sought  by  men,  women,  and. 
children.  Again  proficiency  in  sports,  or  athletics,  or  gym- 
nastics, all  following  some  notion  of  health  that  is  too 
narrow  for  a  stable  or  lasting  foundation. 

Even  the  criterion,  longevity,  will  not  do.  I  was  once 
summoned  in  haste  to  an  old  gentleman,  ninety  years  of 
age,  who  was  in  great  distress  in  some  digestive  way.  I 
said  to  him,  "How  long  have  you  been  suffering?"  He 
said,  "About  fifty  years."  No  one  will  dispute  that  lon- 
gevity upon  that  plan  is  a  bad  hygienic  test.  Yet  how 
many  people  go  through  life  practically  never  well,  and  how 
few,  how  very  few,  know  that  clear,  bouyant,  efficient, 
habitual  well-being  that  marks  the  best  balanced  physique. 

Now  you  will  note  that  I  am  not  confining  my  attention 
to  the  poor,  or  starved,  or  overworked,  or  hmited  in  any  way. 
The  world  at  large  is  under  review,  and  the  classes  with 
every  opportunity  are  open  to  the  same  description  and  to 
far  graver  criticism,  than  the  masses  who  have  no  choice. 

Grave  criticism,  I  repeat,  is  the  moderate  indictment. 
Assuming  that  there  is  such  a  thing  as  moral  obligation  to 


medtc:tn]<:    and    tmip.  r,  if    tie  altfi       191 

all  in  life,  I  do  not  hesitate  to  declare  that  the  most  signal 
duty  of  an  intelli^jjcnt  human  Ix'in^  is  to  ]>e  well. 

That  this  is  not  purely  a  voluntary  matter  goes  without 
saying,  and  tliat  tlie  a])i)roaeh  to  good  health  is  not  to  an 
equal  degree  within  the  reach  of  all,  is,  of  course,  as  clear. 
But  that  the  endeavor  to  be  as  well  as  one's  limitations 
permit  should  be  a  matter  of  duty,  of  conscience,  and  not  a 
matter  of  comfort,  whim,  or  convenience,  I  emphatically 
maintain. 

I  cannot  too  seriously  or  too  unequivocally  put  forth  the 
proposition. 

With  all  the  agitation  of  health  topics  that  is  current; 
with  all  the  countless  array  of  foods  and  garments,  appli- 
ances and  plans;  with  all  the  consulting  of  physicians  and 
employment  of  therapeutics;  the  personal  sense  of  respon- 
sibility, which  amounts  to  a  dominating  influence  in  direct- 
ing our  physical  lives,  is  lacking. 

It  would  be  extreme  to  say  that  all  people  are  living 
unwisely  in  consequence.  That  is  not  the  point.  One  can 
quite  conceive  of  a  well  ordered  and  hygienic  mode  of  life 
that  is  a  matter  of  accident,  or  habit,  or  imitation. 

The  question  is,  How  many  live  as  they  ought,  because 
they  ought,  conscientiously  accepting  the  problem  as  a 
specific  duty  and  fulfilling  it? 

A  general  acquiescence  in  this  abstract  proposition  would 
indicate  that  thinking  folk  see  the  matter  in  this  light. 
The  query  is.  Why  do  so  few  put  into  practice  what  they 
believe  to  be  sound? 

Two  general  considerations  explain  the  failure,  both  of 
the  willing  and  the  thoughtless:  First,  it  is  not  easy,  per- 
haps not  fully  possible,  to  know  what  is  the  thing  to  do. 
Second,  society  has  struck  a  key  in  the  conduct  of  living 
habits,  to  which  everything  becorries  tuned,  and  to  deviate 
to  any  marked  degree  from  the  methods  in  vogue  is  a  matter 
of  the  greatest  difficulty. 

Why  is  it  not  fair  to  presume  that  society  has  evolved. 


192  HENRY     BAIRD     FAVILL 

for  its  own  purposes  and  ends,  a  scheme  of  living  that  is 
in  general  sound  and  sane  —  that  marks  its  conscious  effort 
to  adapt'  itself  to  conditions  of  civilization  ? 

Certainly  it  would  seem  that  that  phase  of  evolution 
ought  not  to  fail  to  justify  itself.  That  it  does  fail  to  justify 
itself  as  to  physical  well-being  is  apparent  to  all  students 
of  the  subject,  and  perhaps  the  broad  reason  is  that  it  is  not 
a  phase  of  true  evolution.  The  essence  of  evolution  is  left 
out,  more  and  more  as  society  "progresses." 

That  essence  is  natural  selection,  the  survival  of  the 
physically  fit.  In  place  of  that  selection  has  come  every- 
thing artificial,  irresistibly  forcing  into  prominence  and 
permanence  factors  and  types  not  at  all  distinguished  by 
physical  perfection. 

How  can  it  fail  to  follow,  that  other  ends  determine  means 
quite  other  than  those  adapted  to  the  highest  physical  ends  ? 

The  result  has  been  that  the  progress  of  the  world  is 
marked  by  a  tendency  to  physical  degeneration,  especially 
in  the  non-laboring  classes. 

I  am  well  aware  that  the  element  of  manual  labor  is  not 
the  necessary  distinguishing  factor,  but  the  phrase  comes 
nearer  to  defining  a  line  between  the  class,  so  absurdly  called 
"upper,"  and  the  classes  which  make  up  the  great  producing 
body,  than  any  that  occurs  to  me. 

It  brings  one  squarely  to  face  this  question  of  the  upper 
class  and  its  progressive  tendency  to  become  unfit.  It  is 
not  necessary  to  undertake  to  demonstrate  the  fact.  I 
have  but  time  to  discuss  briefly  the  ethics  of  it. 

If  there  is  any  justification  of  the  existence  in  society  of 
the  extreme  discrepancies  in  condition  between  the  rich  and 
poor,  it  lies  in  some  interpretation  that  recognizes  a'  right 
to  the  fruits  of  superior  brain  power.  In  some  form  and  to 
some  degree  that  distinction  will  probably  always  prevail. 

The  weak  and  vicious  spot  in  the  scheme  as  it  exists 
is  failure  to  couple  obligations  with  rights. 

If  you  have  a  right  to  the  fruits  of  your  intelligence, 


MICDICINK      A  N  F)      IMJIU.  ir;      FTF.  AI.TF[  193 

what  is  to  prevent  you  from  heeomin^  powerful  to  an 
unlimited  dej^'ree  ? 

Obviously  nothing'  hut  coiidictinj,'  intelligence,  or  a  sense 
of  obligation  to  your  kind.  The  latter  is  the  ethical  note 
that  is  to  be  heard  more  and  more  clear  in  the  future.  It 
matters  not  for  our  purpose  what  it  is  or  how  it  works;  the 
necessary  thing  is  that  it  be  recognized  as  a  fact  qualifying 
all  rights. 

What  right  has  a  portion  of  the  community  to  vitiate  by 
its  mode  of  life,  voluntarily,  its  bodily  integrity  and  that 
of  its  descendants  ?  What  right  to  dissipate  through  physical 
decadence  the  wealth  of  mental  and  moral  superiority  that 
is  the  legitimate  product  of  generations  of  education  and 
opportunity?  What  right  has  a  portion  of  this  class  to 
hound  itself  to  premature  death  by  excessive  ambition, 
or  work  coupled  with  unhygienic  life,  when  its  maturity 
might  yield  years  of  wisdom  and  moral  impetus  to  the 
world  ?  What  right  has  another  portion  to  sink  into  the  dry 
rot  of  self-indulgence,  yielding  nothing  but  bad  example 
to  the  non-discriminating  envious? 

It  is  upon  such  broad  grounds  as  these  that  I  base  my 
statement  that  it  is  one's  high  public  duty  to  be  well.  Am 
I  overdrawing  this  picture?  Do  I  impl}^  a  state  of  affairs 
outside  the  facts? 

Look  at  the  prevailing  health  conditions  in  the  well- 
to-do.  Mark  the  early-  going  to  pieces  of  business  men 
and  women.  Examine  into  the  significance  of  the  con- 
stitutional diseases  that  predominate  in  that  class. 

Listen  to  the  warning  of  the  medical  world  which  sees 
the  preventability  of  the  great  majority  of  these  ailments, 
and  finally  consider  that  these  wrecks  of  lungs  and  livers,  of 
hearts  and  kidneys,  of  brains  and  blood  vessels,  are  in  fact 
wrecks  by  the  time  the}'  are  usually  discovered,  and  that 
most  medical  practice  addressed  to  them  is  but  patchwork, 
striving  to  piece  out  for  a  time  machinery  utterly  spoiled. 

This  picture  is  not  all  so  dark.     There  is  a  time  when  the 


194  HENRY    BAIRDFAVILL 

organs  of  the  body  are  sound.  With  some  variation  there 
is  a  tendency  to  remain  sound  to  a  great  age.  With  careful 
study  there  is  a  way  to  conserve  this  health. 

There  is  a  period  when  this  care  is  as  signally  effective 
as  it  is  useless  after  there  have  occurred  indelible  scars, 
and  this  age  is  from  infancy  to  middle  life.  The  world  is 
beginning  to  take  care  of  its  infants.  It  exercises  some 
supervision  over  its  children.  But  the  adolescent,  the  young 
mature,  the  middle  aged,  what  of  them? 

Is  it  not  the  exception  to  find  individuals  who  thought- 
fully and  conscientiously  take  up  this  problem  as  a  serious 
and  difficult  matter?  Who  do?  Those  already  impaired. 
Who  do  not?  Those  who  are  well  and  strong.  Failing 
utterly  to  see  that  their  vitality  and  resistance  can  carry 
them  into  abuses,  tolerance  of  noxious  agents,  extravagance 
of  resources,  and  accommodation  to  dissipation,  and  all 
with  a  devil-may-care  indifference  that  invites  retribution, 
they  live  by  habit,  imitation,  caprice,  not  by  thought. 

Not  only  is  this  not  an  exaggeration,  but  it  does  not 
begin  to  portray  the  truth.  It  is  time  there  was  an  awaken- 
ing, and  that  health-care,  plan,  and  practice  should  be  a 
fimction  of  youth  and  health,  not  of  age  and  decrepitude. 

This  is  the  view  that  is  hard  to  impress.  It  seems 
unnatural'that  the  young  and  buoyant  should  make  a  study 
of  health,  but  let  me  impress  the  idea  that  it  is  not  health 
that  I  urge  as  a  consideration.  It  is  vicious  habits  as  a 
menace  to  health  that  I  point  out  as  worthy  of  incessant 
study,  and  as  a  postulate  declare  and  then  reiterate  that 
many  of  our  best  established  methods  of  life  being  physi- 
ologically most  vicious,  it  is  necessary  that  the  whole 
subject  be  reviewed  in  the  light  of  physiology,  not  fashion. 

If  it  seems  a  far  cry  from  weakling,  pauper  babies  to 
dissipated  and  thoughtless  youth,  and  that  I  have  strayed 
from  my  subject,  let  me  remind  you  of  several  facts:  — 

That  the  weakling  babies  are  taken  merely  as  a  prom- 
inent and  obvious  example  of  the  plainly  unfit,  whom  we 


M  ic  I)  I  ("  r  N  I-:    AN  I)    p  u  f{  L  I  r:    health       195 

strive  to  pcrpclu.'ilc;  tJiut  they  represent  the  whole  class 
of  feeble  and  indij^cnt  who  care  after  all  the  grave  con- 
sideration. 

That  the  prol^lem  of  dealinj^  with  the  great  mass  is  only 
partially  a  mass  problem,  and  finally  an  individual  problem. 

That  the  scheme  whereby  some  solution  of  this  matter 
is  to  be  reached  must  be  radical  and  extensive. 

That  not  only  must  there  be  brains  applied  to  the  solu- 
tion, but  intense  conviction.  That  only  can  such  con- 
viction dominate  in  those  who  live  by  the  word. 

That  the  greatest  mass  of  thinking,  working,  and  effi- 
cient people  with  educated  intelligence  and  rooted  convic- 
tion, we  hope  is  none  too  great  for  this  colossal  work. 

That  the  hope  of  the  world  in  this  direction,  in  all 
directions,  is  in  the  force  and  energy  of  young  men  and 
women. 

That  the  relatively  efficient  young  men  and  women, 
instead  of  being  to-day  a  rock  to  build  on,  are  in  fully  as 
great  need  of  succor. 

That  as  poverty  is  the  woe  of  the  poor,  abundance  is 
the  greater  menace  of  the  rich. 

That  as  the  poor  are  bound  by  necessity,  the  rich  are 
enslaved  by  convention. 

That  it  is  hence  a  moral  issue  that  calls  on  the  intelligent 
classes  to  become  leaders  in  the  great  work  of  reclaiming 
the  physical  barrens  and  pest  spots,  at  all  levels.  That  the 
initial  step  be  with  infants,  but  to  stop  there  is  not  to  help 
but  seriously  to  damage  the  race.  The  school,  the  class, 
the  club,  the  gymnasium,  the  church,  the  lecture,  the  demon- 
stration, are  all  part  of  the  necessary  machinery. 

The  future  will  see  the  school  of  hygiene  far  more  prom- 
inent than  any  other  school  of  learning. 

I  am  optimist  enough  to  hope  that  it  will  see  hygienic 
living  a  badge  of  intelhgence  and  standing,  and  that  there 
will  be  in  time  to  come  a  dignity  and  power  in  leadership 
in   this  field   quite  commensurate  with  its  importance  as 


196  HENRY     BAIRD     FAVILL 

the  foundation  of  mental  integrity  and  moral  discernment. 

But  even  this  hope,  based  on  the  force  of  altruistic  motive 
that  prevails  in  the  enlightened,  depends  finall}^  upon  the 
individual.  Just  as  there  is  no  hope  for  the  control  or 
coercion  of  masses  in  hygienic  wants,  so  there  is  no  hope  of 
a  comprehending  and  enduring  organic  effort  to  teach, 
except  as  it  grows  out  of  a  true  conception  and  a  corre- 
sponding practice  of  individuals. 

By  as  much  as  there  is  abundant  moral  ground  why 
the  ignorant,  no  matter  how  needy,  should  decline  dicta- 
tion as  to  personal  choice  and  conduct,  by  so  much  is  there 
an  imperative  obligation  upon  the  intelligent  to  enlarge 
the  influence  of  the  truth  by  personal  example. 

No  movement  or  belief  ever  became  a  fixed  and  domi- 
nant factor  in  the  social  structure,  upon  a  basis  of  enactment. 

The  invisible,  insidious,  subtle  contagion  of  thought  is 
what  molds  public  opinion  and  conscience. 

Is  there  any  reason  why  that  permeating  process  should 
be  confined  to  political  or  industrial  reform,  while  the  very 
foundations  of  mental  and  moral  sanity  are  tumbling? 

It  is  true  that,  for  the  overburdened  mass,  opportunity 
must  come  before  they  can  move  or  adjust,  but  it  is  also 
true  that,  if  their  opportunity  were  to  come  to-day,  there  is 
no  prevailing  plan  of  hygienic  living  for  them  to  adhere  to. 

Is  the  prospect  hopeless?  Is  it  worth  the  struggle,  or, 
if  worth  it,  can  the  end  be  accomplished? 

To  those  who  realize  the  difficulties  the  task  is  enormous. 
Those  w^ho  say  it  is  hopeless,  hence  useless,  are  those  who 
say  all  progress  has  come  through  war,  hence  all  time  will 
see  war;  all  government  has  been  dishonest,  hence  all  time 
will  see  it  dishonest;  and  so  on  through  all  the  list  of  con- 
spicuous human  frailties. 

But  there  are  those  who  believe  that  history  need  not 
repeat  itself  forever,  that  there  is  a  future  for  the  race; 
and  to  those  courageous  I  have  but  one  word  to  say, 
Begin  at  the  beginning. 


M  IC  I)  I  (■  I  N  IC      AND      F'  r  I'.  F.  F  C:      HE  A  F,   I   II  197 


Delivered,  Cliieago  Litcniry  Sociel.y,  April  15,  1907. 

THE   DEVELOPMENT   OF   THE   CONCEPTION 
OF    PHYSICAL   WELL-BEING 

LOOKING  over  the  field  of  physical  activities  of  Ameri- 
can youth,  one  must  be  impressed  with  the  enormous 
energy  and  wonderful  skill  developed  in  almost  every 
direction  by  those  who  are  performing  exploits,  which  we 
group  under  the  general  term  of  athletics. 

No  description  will  do  justice  to  the  ambition  and  cour- 
age which  stimulates  to  really  great  achievement.  The 
tendency  spreads  with  great  rapidity,  and,  from  the  village 
green  and  the  city  back-lot  to  the  most  finished  gymna- 
sium, we  find  pouring  forth  streams  of  physical  prowess 
wonderful  in  amount  and  marking  an  unmistakable  quality 
in  its  mental,  moral,  and  physical  bearings. 

To  underrate  the  developmental  value  of  these  activities 
from  every  point  of  view  is  to  ignore  the  fine  adjustment 
between  pride  of  achievement,  vigor  of  body,  and  fidelity 
to  the  rules  of  the  game. 

No  one  can  carefully  regard  the  beautiful  specimens  of 
physical  development  shown  by  men  and  women  in  these 
endeavors,  without  feeling  that  the  nobility  of  the  race  and 
its  possibilities  through  physical  perfection  are  things  to 
be  zealously  cherished. 

Without  cavil,  let  it  be  remarked,  however,  that  the 
present  status  has  been  evolved,  not  only  out  of  an  innate 
thirst  for  contest  and  natural  rivalry,  but  in  response  also 
to  an  ever  increasing  demand  on  the  part  of  the  populace 
for  amusement. 

The  growth  of  professional  athletics  proves  clearly 
enough  that  the  factor  of  amusement  tends  to  become 
predominant,  and  careful  scrutiny  of  the  athletic  world  will 
show  a  variety  of  undesirable  elements  which  creep  in  in 
response  to  this  spectacular  feature. 


tqS  henry    baird    fa V ill 

Whereas  the  total  number  of  performers  increases  enor- 
mously under  this  stimulus,  the  creation  of  a  standard  of 
excellence,  attainable  by  a  comparatively  few,  has  a  dis- 
tinctly inhibitory  influence  at  a  certain  point  upon  uni- 
versal development. 

The  high  degree  to  which  the  factor  of  entertainment 
enters  tends  to  make  this  standard  more  effective.  When 
one  pauses  to  take  an  observation  as  to  the  progress  which 
the  race  is  making  in  physical  development,  he  is  bound  to 
consider  the  influences  bearing  upon  this  evolution. 

It  is  fairly  to  be  assumed  that  magnifying  the  physical 
power  under  the  guise  of  athletics  will  inevitably  develop 
a  large  body  of  athletes.  There,  is,  however,  a  large  ques- 
tion whether  physical  capacity  and  bodily  perfection  are 
thereby  correspondingly  dignified,  and  hence  considerable 
doubt  whether  as  a  permanent  and  imperative  force  the 
athletic  type  is  to  be  relied  upon  to  draw  the  race  on  to  its 
physical  optimum. 

Let  us  candidly  answer  the  question.  Is  the  motive  be- 
hind athletic  achievement,  love  of  contest  and  thirst  for 
victory,  or  is  it  intrinsic  desire  for  self -development  ? 

Upon  the  answer  to  this  question  must  depend  our  con- 
clusions as  to  the  final  adequacy  of  our  present  method  as 
a  means  of  protecting  the  physical  well-being  of  a  people. 

Permit  me  a  moment's  divergence. 

No  one  would  imagine  that  originally  horse  racing  was 
intended  to  be  anything  but  a  sport,  as  natural  and  unob- 
jectionable as  any  other. 

It  was  only  as  it  grew  to  be  a  pursuit  involving  the  use 
of  men  and  resources  to  a  large  extent  that  the  notion  of 
its  favorable  reaction  on  breeding  was  urged,  and  it  is  only 
since  it  developed  into  so  furious  a  business  that  it  has 
failed  to  exert  upon  the  horse  industry  some  favorable 
influence. 

To  be  sure,  as  concerns  the  development  of  speed  in 
the  horse,  there  is  no  doubt  that  the  business  of  horse  racing 


M  E  D  I  C:  I  N  E      AND      IMII'.  [,IC'      HEAI.TII  190 

has  been  the  one  determining^'  influenee  in  .'i  j)henomenal 
development.  But  as  eoncerns  the  establishment  of  good 
and  stable  lines  of  l)reeding  from  which  shall  sjiring  animals 
of  greater  utility  and  perfection,  it  has  had  a  distinctly 
deterring  effect.  All  considerations  having  been  subordi- 
nated to  speed,  it  follows  that  the  essentials,  of  far  greater 
value  to  the  public  than  speed,  are  gradually  dissipated  and 
the  available  stock  of  good  horses  markedly  deficient. 

Theoretically,  this  need  not  have  been  so.  To  have 
carried  along  a  well  balanced  plan,  wherein  speed  should 
have  had  its  due  importance,  would  have  been  possible  and 
sound.  But  the  explanation  is  in  the  psychology  of  the 
thing. 

Thirst  for  victory,  the  intoxication  of  contest,  pride  of 
ownership,  came  to  dominate  the  intelligence  and  effort  of 
those  involved  and  the  deeper  needs  and  purposes  were 
lost  to  view.  If  speed  had  been  sought  in  the  product  only 
in  its  proportion,  the  whole  method  would  have  been 
different  and  the  total  effect  on  the  industry'  beneficial. 

The  idea  that  dominates  is  a  race  horse,  good,  bad,  or 
indifferent,  but  a  race  horse.  How  far  this  has  operated  to 
retard  and  limit  the  development  of  fine  stock  is  a  matter 
of  conjecture,  and  perhaps  of  difference  of  opinion,  but  I 
am  satisfied  that  in  certain  respects  vital  to  the  matter  it 
has  so  influenced  the  outcome. 

Now  this  is  a  problem  in  which  the  terms  are  essential- 
ly under  control.  The  individuals  in  question  are  bred, 
reared,  selected,  trained,  and  utilized  with  no  restraint  upon 
choice  and  judgment.  Even  the  breeder,  as  a  rule,  would 
deny  that  his  aim  and  plan  was  to  produce  speed,  yet,  at 
bottom,  almost  unconsciously  that  is  the  line  upon  which 
his  effort  proceeds. 

Out  of  thousands  but  one  great  racer  is  bom,  and  yet  with 
all  the  commercial  pressure  that  belongs  to  the  matter  of 
value  in  the  rank  and  file  of  utility  horses,  the  gaze  of  the 
breeder  is  still  fixed  upon  speed. 


200  HENRY     BAIRD     FAVILL 

Whatever  may  be  the  fate  of  the  horse  industry,  I  cite 
this  to  illustrate,  first,  the  effect  upon  a  great  industry  of 
an  intercurrent  idea,  and  second,  the  difficulty  of  substi- 
tuting for  a  primary  and  so  to  speak  human  impulse  an 
academic  design. 

When  the  lust  of  preeminence,  concentrating  all  ener- 
gies upon  a  winner,  becomes  so  great  as  ruthlessly  to 
sacrifice  the  mass  out  of  which  the  prodigy  arises  as  a 
specialized  offshoot,  the  good  of  the  process  to  the  mass 
disappears. 

The  analogy  between  this  illustration  and  the  subject 
that  I  am  discussing  is  restricted,  but  at  a  point  definite. 
Specialization,  selection,  and  forcing,  having  as  an  end  vic- 
torious contest,  can  react  as  a  developmental  influence  to 
the  advantage  of  the  mass  of  individuals  only  in  so  far  as 
it  combines  some  effective  stimulus  and  opportunity  to  the 
more  limited,  and  when  it  by  chance  creates  conditions 
that  interrupt  stimulus  and  restrict  opportunity  it  becomes 
increasingly  a  bar. 

These  are  essentially  the  factors  in  the  problem  of  Ameri- 
can athletics  to-day,  barring  any  opportunity  to  control 
the  product  by  breeding. 

Let  us  take  athletics  as  organized  in  our  colleges  as  a 
type. 

Right  at  the  outset  I  might  as  well  meet  my  disputant, 
who  will  deny  that  the  end  of  athletic  method  in  college  is 
to  produce  winners. 

I  can  only  affirm,  and  maintain  by  reference  to  com- 
mon observation.  No  one  can  fairly  weigh  the  facts  and 
fail  to  reach  that  conclusion. 

Irrespective  of  the  moral  obliquity,  the  intrigue  and 
chicanery  that  creep  into  the  practical  operations  of  the 
machinery  of  winning  contests,  the  thing  itself  in  its  nar- 
rowness of  specialization  is  an  inhibitory  influence  upon 
the  conscious  and  intentional  culture  of  the  great  mass  of 
students. 


M  I<:  I)  I  C  1  N  !•:      AND     P  U  15  I.  I  (;      III.  A  I,  in  2or 

What  haj)pcns?  At  the  hcj^inning  of  a  student's  career, 
the  question  very  ])rom]jtly  arises,  Is  he  or  is  he  not  given 
to  athletics? 

Under  the  present  phase,  a  very  large  percentage,  I 
think  the  majority,  of  students  are  by  that  test  tacitly 
excluded.  I^^or  those  who  are  or  who  would  like  to  be 
athletic,  the  following  course  is  open: 

According  to  the  season  of  the  year,  the  makeup  of  the 
various  athletic  teams  is  in  progress.  Scores  of  youngsters 
get  out  in  various  performances  to  be  inspected  and  tried 
out  for  positions  on  the  teams.  Week  by  week  this  list 
dwindles  as  here  and  there  a  man  is  picked  up  who  is  signally 
proficient.  In  the  course  of  time,  the  teams,  including  sub- 
stitutes, are  rounded  out.  So  far  as  the  individuals  who 
are  successful  in  making  the  teams  are  concerned,  there  is 
lacking  neither  stimulus  nor  opportunity.  They  are  put 
through  a  curriculum,  more  or  less  severe,  more  or  less 
judicious,  and  brought  from  time  to  time  into  strenuous 
contest.  Of  course,  in  their  practice  contests  it  is  intra- 
collegiate.  The  ultimate  purpose,  however,  is  inter-colle- 
giate contest,  and  to  this  end  all  energies  are  directed. 

Nobody  can  question  the  high  degree  of  physical  devel- 
opment, and  I  will  even  consider  mental  and  moral  effi- 
ciency, which  can  come  to  these  individuals  as  the  result 
of  their  experience. 

No  one  can  question  the  degree  of  enthusiasm  and  the 
intensity  of  interest  and  the  eagerness  for  victory  which 
concentrates  upon  these  teams  from  the  whole  college  body. 

I  think  it  would  hardly  be  worth  while  to  discuss  the 
truth  of  the  theory  that  hereb\^  an  overwhelming  esprit  de 
corps  is  developed. 

Supposing  that  to  be  conceded.  How  much  does  it  all 
bear  upon  the  point,  namely,  the  ph^^sical  education  of  the 
students  of  a  university?  First,  let  us  examine  somewhat 
the  curriculum  of  the  team.  Its  required  habits  are  exem- 
plary;  smoking,   drinking,   and  dissipation   are  forbidden. 


202  HENRY     BAIRD     FA  V  ILL 

Certainly  the  implication  as  to  the  physical  value  of  absti- 
nence ought  not  to  be  thrown  away. 

Upon  how  many  of  these  participants  is  the  lesson  at 
all  effective  ?  How  many  of  them  regard  it  as  anything  but 
a  means  to  an  immediate  end  rather  than  as  a  suggestion 
for  life? 

Even  limited  observation  answers  that  question  unequiv- 
ocally. These  team  men  are  put  through  a  hard  physical 
drill.  To  what  extent  it  is  extreme,  may  be  a  question. 
Beyond  doubt  many  individuals,  who  are  physically  unequal 
to  the  test,  are  injured,  but  without  insisting  upon  that 
point,  let  us  assume  that  they  have  a  fine  curriculum  for 
physical  development. 

To  what  extent  do  they  acquire  methods  or  habits  of 
life  based  upon  physical  exertion,  which  they  incorporate 
into  later  life  and  utilize  for  their  own  and  others'  benefit? 

Again,  limited  observation  leads  one  to  the  conclusion 
that  it  is  exceptional  when  a  man  of  this  experience  is  a 
man  of  wise  physical  habits  in  subsequent  life. 

Many  of  these  individuals  are  fed  with  care  upon  certain 
definite  lines. 

It  has  become  perfectly  clear  recently  that  the  hypoth- 
esis upon  which  the  training  table  has  been  conducted  has 
been  wrong,  and  there  can  be  no  doubt  that  so  far  as  the 
influence  of  this  feature  upon  college  intelligence  goes,  it 
has  been  in  the  direction  of  misinformation  and  almost 
ineradicable  error. 

However,  it  must  be  admitted  that,  on  the  whole,  if 
the  students  who  become  participants  in  athletic  contests 
derive  a  preponderance  of  benefit,  it  is  by  no  means  com- 
mensurate with  the  opportunity  existing. 

What  on  the  other  hand  is  the  effect  upon  non-parti- 
cipants ? 

Perhaps  it  will  be  said,  not  any.  It  may  be  said  that 
colleges  require  compulsory  gymnastics  for  those  who  do 
not  "make"  the  teams;  that  this  occurs  under  supervision 


MEDICINE     AND      I'  li  I'.  I.  I  f      HEALTH  203 

and  that  the  general  (hifl  is  toward  physical  improvement. 

It  is  true  that  most  colleges  have  some  gymnasium 
requirement  and  that  a  considerable  proportion  of  students 
do  something  at  it. 

My  observation  and  inquiry  lead  me  to  the  conclusion, 
however,  that  it  is  desultory,  more  or  less  interrupted,  and 
without  any  definite  plan  of  physical  culture. 

The  stimulus  to  marked  physical  exercise  has  been  inter- 
rupted by  the  limitations  upon  the  numbers  who  can  com- 
pose a  team. 

The  notion  of  conspicuous  contest  and  victory  having 
become  the  prominent  and  determining  motive,  it  follows 
that  the  incentive  to  the  less  capable  students  is  gone. 
There  is  no  place  to  show.  There  is  no  eclat.  There  is  no 
decisive  issue.     Hence,  what  is  the  use? 

Stimulus  has  disappeared  with  opportunity.  Whether 
one  can  declare  that  it  is  the  result  of  this,  or  not,  one  can 
declare  with  fairness  the  fact,  that  the  general  physical 
quality  of  college  students  is  far  below  its  normal  possi- 
bilities, and  almost  every  individual  can  be  strongly  criti- 
cized in  some  direction  or  other  as  to  his  physical  life. 

It  might  be  objected  that  it  is  absurd  that  the  mere 
lack  of  exhibition  opportunity  should  snufif  out  the  natural 
impulse  of  youth  to  physical  growth;  that  it  is  crediting 
youth  with  altogether  too  small  initiative  and  principle. 

It  must  be  borne  in  mind  that  the  youth  in  question  is 
at  the  most  impressionable  age,  most  susceptible  to  strong 
suggestion,  and  that  gregarious  youth  is  as  resistant  to  force 
and  as  hopeless  in  its  inertia  as  anything  that  one  can 
picture. 

What  can  be  done  with  youth,  can  be  done  only  through 
ideals,  never  through  coercion,  and  it  is  the  ideal  in  question 
with  which  I  contend ;  and  this  leads  me  again  to  call  atten- 
tion to  my  statement.  Not  that  college  athletics  do  not 
adequately  foster  physical  education,  but  that  they  are 
distinctly  a  hindrance  thereof. 


204  HENRY     BAIRD     FA  V  ILL 

So  long  as  the  ideal  is  as  it  is,  so  long  as  college  suprem- 
acy is  the  rallying  point  of  athletic  spirit,  and  so  long  as 
extraordinary  prowess  is  the  chief  pride  of  the  student  body, 
so  long  will  the  physical  education  of  men  fail  to  bear  its 
legitimate  fruit. 

Let  us  acknowledge  that  a  small  percentage  of  men  are 
physically  so  endowed  that  they  could  become  in  any 
reasonable  sense  athletes.  Let  us  admit  that  the  great 
majority  of  students  must  of  necessity  fall  short  of  anything 
approaching  a  contesting  grade.  After  all,  does  not  that 
again  open  the  question,  which  is  to  my  mind  the  crux  of 
the  whole  matter,  whether  we  do  not  entirely  fail  to  realize 
the  difference  between  that  over-development,  which  is 
covered  by  the  word  athletics,  and  that  normal  and  sym- 
metrical development  which  might  be  covered  by  the  word 
gymnastics  ? 

I  repeat,  this  is  the  crux  of  the  whole  matter. 

There  is  no  individual  in  college  physically  so  limited 
that  there  is  not  for  him  a  degree  of  physical  improvement 
and  perfection  distinctly  better  than  he  attains. 

From  the  weakest  to  the  strongest,  the  poorest  to  the 

■  best,  'the  most  struggling  physical  economy  to  the  most 

perfect,    there   are   possibilities   of  physical   improvement, 

through  intelligent  and  judicious  effort,  which  could  largely 

determine  future  physical  life. 

It  is  perfectly  evident  that  from  this  point  of  view  we 
see  an  entirely  new  territory.  Viewed  as  a  cultural  matter 
from  the  standpoint  of  individual  profit,  as  should  be  viewed 
every  item  in  the  college  curriculum,  the  subject  gains 
importance  and  dignity. 

If  it  be  true  that  intelligent  development  can  correct 
vicious  physical  tendency,  fortify  feeble  physiologic  power, 
and  stimulate  desirable  and  pleasurable  hygienic  habit, 
there  ought  to  be  no  question  as  to  the  imperative  necessity 
of  including  in  our  scheme  of  education  these  profoundly 
influential  factors. 


MTU)  T  f  T  N  E      ANT)      T' U  T?  T,  T  C      II  I",  A  I.  Til  205 

That  these  things  arc  l,nic  I  linvc  no  lime  to  undertake 
to  demonstrate,  hut  without  licsitation  or  (luah'fieation  I 
aSvSert  them. 

All  phyvSical  trainers  and  students  of  the  subject  know 
that  it  is  true.  As  a  rule  college  curricula  take  some  cogniz- 
ance of  the  facts  and  are  measurably  adjusted  thereto. 

Why,  then,  is  it  that  so  little  is  accomplished  and  that 
the  drift  is  not  noticeal)ly  toward  better  things? 

Again  1  invoke  the  influence  of  ideals.  The  notion  of 
physical  perfection  has  little  ground  in  our  modern  concep- 
tion. The  obligation  of  an  individual  to  be  at  his  best 
physically  is  hardly  recognized  even  by  the  most  intelligent. 

That  a  man  should  make  the  most  of  himself  mentally 
or  be  punctilious  morally  is  a  well  settled  principle  of  life, 
but  that  he  is  under  obligation  from  an  ethical  standpoint 
to  make  his  physical  life  as  good  as  possible  rarely  enters 
the  mind  of  anybody.  It  is  this  that  is  the  foundation  of 
the  whole  argument. 

There  must  be  introduced  into  the  lives  of  young  men, 
and  especially  college  men,  a  new  ideal  as  to  physical  ethics, 
and  out  of  that,  and  only  out  of  that,  perhaps,  will  spring 
the  reconstruction  of  the  general  conception  of  this  matter, 
by  the  people. 

It  seems  to  me  that  the  attitude  and  conduct  of  colleges 
in  this  field  ought  to  be  a  determining  influence  upon  the 
general  public.  That  the  general  public  is  suiTering  from 
the  same  perversion  of  physical  ideals,  is  clear  enough. 

To  what  extent  this  is  due  to  college  example  is  ques- 
tionable, but  that  college  example,  as  a  high-grade  demon- 
stration of  the  true  course,  could  and  would  react  favorably 
on  the  general  public,  I  believe  there  can  be  no  question. 

Tw^o  things  make  it  imperative  that  colleges  should 
realize  this  necessity.  On  the  one  hand,  their  students  have 
none  of  the  corrections  of  normal  and  necessary  labor  leading 
them  to  more  or  less  automatic  cultivation  of  the  physique. 
Hence  schools  fail  in  immediate  obligation. 


2o6  HENRY     BAIRD     FAVILL 

On  the  other,  the  educated  minority  of  society  owes  an 
obligation  toward  the  elevation  of  standards  and  methods 
so  clear  that  it  would  be  trifling  to  discuss  it. 

No  one  ever  questions  the  obligation  which  rests  upon 
the  more  educated  and  enlightened  citizens  in  the  upholding 
of  standards  of  living,  individual  and  public.  I  question, 
however,  whether  it  ever  occurs  to  these  presumably  enlight- 
ened that  they  have  a  function  by  precept  and  example  in 
molding  the  public  conception  by  hygienic  living. 

What,  then,  is  the  solution  of  what  seems  to  be  a  present 
and  progressive  vice  in  the  physical  life  of  the  college? 

I  recall  my  own  most  intimate  observation  in  passing. 

Where  I  was  in  college,  there  were  no  athletics;  no  foot- 
ball, rarely  baseball,  no  track  teams,  sporadic  boating,  no 
athletic  contests  of  any  kind.  So  far  as  I  know  the  students 
were  of  average  physical  condition,  to  a  large  extent  men  of 
moderate  means,  many  of  them  coming  from  the  strong 
physical  experience  of  the  farm.  Such  a  thing  as  a  notice- 
able group  of  physically  superior  men  was  hardly  considered. 

Of  course,  in  a  college  body  so  made  up,  the  dissipation 
of  the  students  on  the  average  would  be  small.  On  the 
other  hand,  in  the  small  group  whose  circumstances  would 
permit  it,  the  average  dissipation  was  great. 

Since  that  time  there  has  grown  up  in  that  college  a 
strong  athletic  spirit.  College  achievement  and  college 
supremacy  have  reached  their  highest  pitch  in  the  student 
enthusiasm.  Noticeably,  athletic  politics  and  athletic  in- 
trigue have  at  times  reached  their  most  obnoxious  develop- 
ment. 

So  many  changes  in  the  material  circumstances  of  the 
student  body  have  occurred  in  the  few  years  in  question, 
that  it  would  be  unfair  to  compare  habits  or  draw  con- 
clusions therefrom,  but  as  concerns  the  physical  develop- 
ment and  personal  quality  of  the  student  body,  so  far  as 
I  can  learn,  it  not  only  has  not  improved  but  has  rather 
deteriorated,  and  this  in  the  face  of  the  fact  that  it  produces 
teams  of  the  very  first  quality. 


M  E  I)  I  C  I  N  !<:      AND     PUBLIC     IT  E  A  L  T  II  207 

The  college  can  go  insane  over  an  inter-collegiate  contest, 
and  almost  nothing  can  be  done  in  the  way  of  systematic 
student  training. 

This  only  serves  to  em]jhasize  what  I  commented  upon 
with  regard  to  horse  racing;  one  cannot  force  upon  a  process, 
like  horse  racing  or  boat  racing,  an  arbitrary  and  really 
foreign  ulterior  purpose  with  any  hope  of  success.  These 
contests  are  not  the  expression  of  an  elevated  physical 
development  in  the  bodies  from  which  they  spring,  but  are 
examples  of  more  or  less  fortuitous  specialized  and  adapted 
capacity. 

To  cater  to  the  supply  of  these  qualities  is,  in  the  first 
place,  to  lose  sight  of  the  primary  object,  physical  perfec- 
tion, and  in  the  second  place,  to  eliminate  from  the  develop- 
mental curriculum  upwards  of  ninety  per  cent  of  all  the 
individuals  available. 

Students  must  remain  students.  Contests  must  remain 
contests.  College  pride  must  stand  for  what  it  is,  but  the 
physical  progress  and  culture  of  mankind  has  got  to  pro- 
ceed from  foundations  entirely  different,  under  ideals  far 
higher  and  more  imperative  and,  to  repeat  my  language, 
by  methods  conscious  and  intentional. 

When  this  readjustment  can  come  to  pass,  it  is  safe  to 
say  that  college  teams  and  college  sports  can  be  affected 
only  favorably  thereby. 

Until  it  comes  to  pass,  and  while  the  athletic  ideal 
remains  in  its  narrow  specialized  and  unintelligent  form, 
college  athletics  will  continue  to  be,  as  in  my  judgment 
they  distinctly  are,  a  means  of  diverting  from  normal  and 
desirable  development  the  energies  and  purposes  of  that 
great  mass  of  maturing  men  and  women  upon  whose  future 
is  dependent  the  welfare,  to  an  immeasurable  degree,  of  the 
social  body. 

What  is  to  be  done  in  these  conditions  is  quite  as  ser- 
ious and  difficult  a  problem  as  any  that  faces  the  college 
authorities. 


2o8  HENRY     BAIRD     FAVILL 

The  facts  are  well  recognized;  the  solution  is  not  clear. 
Perhaps  the  most  difficult  element  in  the  case  is  the  neces- 
sity of  fitting  or  acquiring  a  taste  on  the  part  of  the  stu- 
dents sufficient  to  outweigh  the  various  interferences  with 
normal  physical  ways  which  life  presents. 

It  is  curious  to  note  how  greatly  lack  of  experience  and 
opportunity  has  to  be  misinterpreted  into  an  apparent 
distaste. 

It  is  rare  that  any  individual  takes  up  any  form  of 
physical  exertion  without  finding  in  it  a  distinct  pleasure 
corresponding  to  its  benefit.  The  history  of  golf  in  its 
relation  to  staid  and  hopelessly  inert  business  men,  or  to 
sluggish  and  over-domesticated  women,  is  an  excellent 
illustration.  The  combination  of  a  stimulating  out-of-door 
life,  coupled  with  some  interest  in  achievement,  proves 
to  be  fascinating  to  those  who  supposedly  are  rooted  in 
their  abnormal  civilization. 

The  history  of  men  who  have  taken  up  various  forms 
of  outing,  oftentimes,  reluctantly  and  with  misgiving,  but 
almost  invariably  with  resulting  fascination  and  delight, 
shows  clearly  enough  that  lack  of  comprehension  rather 
than  lack  of  taste  is  the  fundamental  fault. 

The  observation,  open  to  the  few  physicians  who  take 
any  stock  in  that  sort  of  thing,  of  individuals  who  are  put 
under  systematic  gymnastic  training  as  a  measure  of  medical 
treatment,  shows  beyond  any  doubt  that  even  this  restricted 
joy  has  in  it  as  a  rule  definite  pleasurable  result.  The 
difficulty  with  all  of  these  questions  of  pursuits  is  not  their 
distastefulness  but  the  complexity  of  life  which  tends  to 
crowd  them  out. 

Only  by  giving  essentials  their  proper  weight  can  the 
relative  adjustment  of  time  and  energy  be  secured.  If 
by  chance  we  could  come  to  be  as  insistent  upon  our  needs 
for  physical  activity  as  we  are  for  our  food,  the  problem 
would  be  solved. 

It  is  clear,  therefore,  that  the  difficulties  with  respect 


M  K  I)  I  C:  I  N  K     AND     IMII'.l.ir     iii-;ai,'iii         209 

to  the  college  years  are  great.  To  arrange  college  life  so 
that  normal  and  fitting  j^hysical  activities  become  a  part 
of  its  contribution  to  the  welfare  of  mankind  may  not  he 
solved.  It  ought  to  be  possible,  however,  to  jirevent  it 
from  being  an  insuperable  bar  to  future  education. 

I  think  it  is  agreed  that  college  sports  should  become 
more  diversified,  that  there  should  be  forms  of  play  to  which 
all  students  could  have  access  and  for  which  they  could  be 
reasonably  fitted. 

Read  the  old  Rugby  tales  of  football  and  compare  them 
with  the  modern  football  performances.  Take,  for  exam- 
ple, the  so-called  Soccer  football,  which,  rough  and  stren- 
uous as  it  is,  after  all  puts  a  premium  upon  agility  and 
courage  rather  than  upon  strength  and  bulk. 

There  is  no  end  to  this  possible  development  of  sports, 
in  some  phase  and  by  some  arrangement  of  which  all  stu- 
dents can  be  fitted,  providing  one  can  check  the  concen- 
tration of  student  thought  upon  a  handful  of  prodigies 
called  a  "team,"  which  may  be  able  to  win  a  game  from 
some  rival. 

Even  this,  however,  does  not  adequately  meet  the  con- 
ditions. The  contesting  age  in  strenuous  sport  is  over, 
comparatively  early.  The  contest  in  public  is  practically 
over  at  the  end  of  college  life. 

What  has  the  student  acquired  in  the  way  of  physical 
tastes  which  shall  lead  him  to  go  on  cultivating  his  bodily 
powers,  adapting  himself  from  period  to  period  to  the 
proper  activities?  I  think  it  must  fairly  be  said  that  he 
has  acquired  very  little. 

If  this  important  four  years,  which  might  yield  such 
great  results,  yields  only  indifference,  to  that  extent  it  is  a 
reproach  to  the  intelligence  of  our  educators. 

I  had  no  intention  to  preach  a  sermon  in  hygiene,  but 
one  word  I  feel  is  due.  The  habits  of  a  man  at  thirty  bear 
fruit  at  fifty.  The  changes  at  middle  age  and  beyond, 
which  have  become  so  marked  that  the}^  bear  the  names  of 


2IO  HENRY     BAIRD     FAVILL 

diseases,  are  really  terminal  and  indelible  scars  for  the  cor-, 
rection  of  which  no  one  is  able  to  do  much.     Morbid  pro- 
cesses of  the  destructive  type  are  hidden  and  rarely  bear  an 
obvious  relation  of  cause  and  effect. 

Not  infrequently  the  period  of  highest  physical  stimu- 
lation and  sense  of  well-being  immediately  precedes  a  bodily 
storm.  All  manner  of  obscurity  and  confusion  surrounds 
these  topics.  To  be  governed  in  one's  plans  about  these 
things  by  one's  present  feeling  is  fully  as  irrational  as  to  be 
governed  in  one's  fire  insurance  or  life  insurance  by  a  sense 
of  present  security. 

There  are  laws  of  hygiene  as  well  established  as  almost 
any  other  laws  of  life,  but  the  average  man,  doctor  or  lay- 
man, rarely  gives  them  thought.  We  are  creatures  of  imi- 
tation rather  than  of  intelligent  action,  and  it  is  likely  that 
habit  will  always  determine  the  average  status  of  civilized 
people.  It  becom.es,  therefore,  the  more  imperative  that 
habits,  based  upon  sound  principles  rather  than  emotional 
extravagance,  should  be  inculcated  in  youth.  Yet  it  will 
be  a  long  story  before  what  now  constitutes  the  spirit  of 
college  can  be  transformed  into  a  pervading  pride  in  the 
physical  perfection  of  its  student  body. 

Is  it  visionary  to  hope  that  determined  effort  on  the 
part  of  educators  at  all  stages  can  favorably  influence  this 
development  ? 

Is  it  useless  to  try  to  impress  the  importance  of  this 
matter  upon  those  who  are  engaged  in  the  training  of  youth  ? 

Is  there  any  fallacy  in  the  argument  in  favor  of  an  ideal 
conception  of  physical  well-being? 

To  all  of  these  questions  I  answer,   emphatically,   No! 

We  do  need  an  ideal  in  physical  education.  Not  only 
educators,  but  all  serious  thinkers  admit  these  essential 
propositions. 

For  those  two  reasons  it  is  clearly  within  a  reasonable 
hope  that  our  educational  forces  will  before  long  determine 
a  standard  which  will  be  to  the  race  an  unmitigated  blessing. 


M  E  D I  c  I  N  p:    and    p  u  n  r.  I  r     ir  k  a  r.  t  if       2  r  r 

Delivered,  Commercial  CIul)  Ban(|uct,  January  II,  1908. 

TUBERCULOSIS 

THE  committee  entrusted  with  this  program  has  chosen 
to  concentrate  the  discussion  upon   the  subject  of 
tuberculosis.     Amongst  many  reasons  for  this,  there 
are  four  which  are  important: 

1.  Tuberculosis  is  a  form  of  infectious  disease  not 
obvious,  but  by  reason  of  general  discussion  greatly  dis- 
torted in  the  public  mind  as  to  the  nature  of  its  dangers. 

2.  Because  it  represents  to  a  high  degree  the  principle 
underlying  our  management  of  infection,  viz.,  that  intelli- 
gent effort  put  forth  at  the  proper  point  practically  removes 
it  from  the  category  of  diseases  which  are  a  public  menace. 

3.  Because  of  all  the  diseases  with  which  we  have  to 
deal  from  the  standpoint  of  the  community,  there  is  none 
which  is  more  important  in  bringing  about  conditions  of 
dependence  and  pauperism,  with  which  are  associated  all 
great  philanthropic  problems  of  the  day. 

4.  Because  to  a  degree  hardly  equalled  by  any  infec- 
tious disease,  it  is  amenable  to  treatment,  but  to  early 
treatment  only. 

It  therefore  seems  that  the  earnest  and  determined 
interest  of  this  body  of  men  can  with  propriety  focus  upon 
this  point  for  the  time  being.  It  is  not  m}^  purpose  to  dis- 
cuss at  length  the  broad  humanitarian  aspects  of  tubercu- 
losis, nor  to  point  in  effective  colors  the  infinite  woe  which 
it  brings  into  the  world.  It  is  worth  a  moment  of  time, 
however,  to  note  the  widespread  agitation  traveling  over 
the  world  upon  this  subject,  and  to  inquire  briefly  into  its 
reasons. 

Educational  effort  starting  in  a  few  places,  spreading 
through  the  medical  profession  out  into  the  bodies  inter- 
ested in  similar  topics,  and  again  out  into  the  people,  has 
gradually  brought  the  majority  of  the  civilized  communities 


212  HENRY     BAIRD     FAVILL 

into  considerable  recognition  of  the  great  facts  of  tuber- 
culosis. Line  b}''  line  and  point  by  point  this  lesson  has 
been  brought  into  the  field  of  general  intelligence,  until 
there  has  finally  come  to  exist  a  familiarity  with  the  fact 
of  tuberculosis  even  though  the  nature  of  it  be  somewhat 
vaguel}^  understood.  Hence,  the  first  factor  in  this  world 
movement  is  comprehension. 

Inevitably,  in  the  progress  of  such  a  wave  of  intelligence, 
the  attention  of  the  people,  whose  minds  reach  out  into 
community  problems,  has  been  attracted.  They  have  seen 
that  there  exists  in  our  midst,  in  the  midst  of  every  civilized 
community  in  the  world,  a  grievous  plague,  that  it  is  the 
source  of  indescribable  distress,  incomputable  economic 
loss,  and  unmistakable  danger  to  this  and  succeeding  gener- 
ations, and  above  all,  that  it  is  theoretically  possible  to 
remove  it  from  the  field  of  human  disaster. 

Upon  all  these  propositions,  as  a  foundation,  the  aggres- 
sive workers  in  the  medical  and  philanthropic  field  have 
become  imbued  with  the  belief  that  among  the  world  prob- 
lems which  demand  attention,  none  is  greater  or  more 
imperative  than  tuberculosis. 

Following  upon  all  this  development  of  opinion  comes 
the  practical  demonstration,  fragmentary,  imperfect,  and 
piteously  small,  but  none  the  less  clear,  that  it  is  possible 
practically  to  cope  with  this  question.  Out  of  this  has 
arisen  what  is  necessary  to  stand  behind  every  great  and 
permanent  movement,  conviction.  Such  conviction  having 
been  reached,  it  is  as  true  here  as  in  every  field  of  human 
thought  and  endeavor,  that  it  is  impossible  to  stop  the 
determined  impulse  to  combat  this  public  foe. 

Upon  all  of  these  phases  one  might  comment  at  great 
length,  but  time  forbids.  The  questions  which  we  want  to 
consider  are  few  and  definite. 

In  this  community,  with  reference  to  this  body  of  busi- 
ness men,  with  reference  to  the  body  of  professional  men, 
with  reference  to  the  social,  domestic,  and  economic  life  of 


M  IC  I)  I  (    I  N  IC      AND      I'  I;  I'.  L  I  (        III'.  A  LI   11  21.5 

this  whole  peo])le,  whore  does  this  question  stand?  Should 
we  consider  it  from  the  standpoint  of  the  danger  that  exists 
for  every  one  of  us  and  our  children,  or  shall  we  discuss  it 
from  the  stan(l])()itil  of  the  enormous  body  of  suffering 
human  beings  who  arc  already  in  the  toils,  or  from  the  stand- 
point of  the  State  which  is  being  deprived  of  its  citizens,  or 
from  the  standpoint  of  the  relief  forces  in  the  community 
which  are  carrying  on  the  burden  of  this  disability? 

Upon  any  one  of  these  aspects  one  might  talk  with  fer- 
vor, indefinitely.  It  is  impossible  to  more  than  touch  upon 
them.  Let  us  glance,  however,  at  the  actual  charitable 
problem. 

It  is  well  known  that  accident  and  sickness  cause  the 
vast  preponderance  of  dependence  in  the  community.  It 
is  probably  not  so  well  known  that  an  analysis  of  the  facts 
concerning  large  bodies  of  people  who  receive  relief  will 
show  that  in  10  per  cent  of  the  families  so  relieved,  there  is 
tuberculosis.  Of  the  families  making  up  this  10  per  cent, 
over  75  per  cent  will  involve  either  the  father  or  the  mother, 
and  so  far  as  my  present  information  goes,  the  disease  of 
the  father  preponderating  over  the  mother  in  the  ratio  of 
about  4  to  I.  This  means  that  with  ver}^  few  exceptions 
those  families  are  permanently  in  need  of  public  help.  Of 
the  members  of  these  families,  23  per  cent  will  show  tuber- 
culosis in  some  degree,  and  yet  in  only  about  4  or  5  per  cent 
of  the  families  immediatel}^  under  consideration  have  there 
already  been  deaths. 

This  latter  fact  is  of  great  significance.  It  shows  in  the 
first  place  that  this  is  not  a  progressive  performance,  going 
on  from  generation  to  generation  and  following  the  family 
from  point  to  point,  but  it  shows  that  it  is  springing  up 
anew  in  families  previously  immune,  and  so  far  as  we  can 
see,  for  no  reason  other  than  the  social  and  economic  condi- 
tions under  which  these  people  go  on.  It  shows,  more- 
over, that  this  is  not  a  sudden  blow  that  falls  upon  the  f amil^^ 
and  is  over.     It  is  a  continuous  burden  which  goes  on  and 


214  HENRY     BAIRD     FAVILL 

on  for  months  and  years,  and  which  in  any  event  becomes 
a  source  of  financial  burden,  and  in  the  case  of  the  father 
or  mother,-  a  matter  of  hopeless  struggle. 

An  analysis  of  a  large  number  of  typical  cases  of  tuber- 
culosis in  the  man  of  the  family  will  show  an  average  reduc- 
tion in  wage  from  $13  a  week  in  health  to  $4  a  week. 

Bear  in  mind  that  in  this  consideration  we  are  not  deal- 
ing with  the  dregs  of  the  community.  We  are  dealing  with 
the  best  of  our  industrial  people;  the  people  who  have 
worked  hard  to  advance  themselves;  who  have  in  conse- 
quence had  to  labor  unduly;  who  have  assumed  responsi- 
bilities and  carry  them  to  the  last  minute;  who  are  forced 
by  absolute  necessity  to  drop  down  and  down  in  the  scale 
of  living. 

Even  amongst  the  recipients  of  relief,  living  conditions 
are  not  the  worse.  In  a  group  of  cases  under  analysis,  there 
was  something  more  than  an  average  of  one  room  to  two 
people.  These  are  people  of  more  or  less  delicate  stripe, 
many  of  them  unaccustomed  to  hardship  and  unfit  for  the 
heaviest  labor,  but  who  are  brought  day  by  day  and  month 
by  month  into  the  most  dire  conditions. 

One  sees  all  phases,  but  almost  invariably  they  respond 
to  the  same  test.  Would  timely  help  have  avoided  the 
situation?     Almost  invariably  the  answer  is,  yes. 

I  approach  with  diffidence  the  next  question:  the  eco- 
nomic value  of  a  life.  I  hesitate  partly  because  one  dis- 
likes to  put  too  much  stress  upon  that  phase  and  partly 
because  the  statistics  upon  this  subject  may  be  open  to 
question.  However,  let  me  say  in  a  word,  and  roughly  as 
to  accuracy,  what  the  statistician  would  say: 

In  Chicago,  in  1907,  there  were  3,477  deaths  from 
tuberculosis.  Assuming  the  value  of  an  individual  life  to 
the  community  to  be  $1,500,  which  is  the  economist's 
assumption,  these  3,477  persons  are  worth  to  Chicago 
$5,215,000;  the  expense  of  carrying  them  through  their 
sickness  on  a  270  days'  average  was  $675  apiece,  including 


M  E  UI  C;  I  NIO      AND     P  U  IJ  L  I  C      111.  A  LI   II  215 

loss  of  service  during  that  period.  It  makes  the  expense 
account  $2,355,000;  a  total  estimated  loss  in  one  year  to 
this  community  of  $7,565,000. 

I  shall  not  stop  to  discuss  any  fallacies  that  may  lie  in 
this  argument.  There  is  enough  truth  to  it  and  it  is  suffi- 
ciently accurate  to  show  that  the  actual  waste  of  resources 
in  this  community,  due  directly  and  indirectly  to  consump- 
tion, is  colossal.  This  is  worth  bearing  constantly  in  mind. 
I  desire  to  emphasize  it  for  one  specific  reason :  the  impulse 
to  step  in  and  relieve  this  situation  is  greatest  from  its 
humanitarian  side.  Everyone  of  you  is  stirred  most  deeply 
by  the  knowledge  of  suffering  and  distress  of  your  fellow- 
men.  On  the  other  hand,  I  think  history  will  show  that 
plans  of  relief  and  methods  of  remedy  are  more  stable,  more 
cogent,  and  more  easily  established  from  the  economic 
side,  and  it  is  obvious  that  it  is  an  important  factor.  But 
again,  we  must  face  the  picture  of  the  suffering  surrounding 
the  situation.  The  heart-rending  struggle  of  the  bread- 
winner to  keep  up;  the  mental  anguish  he  suffers  as  he  sees 
the  fight  going  against  him;  the  actual  suffering  of  himself 
and  his  children;  the  long  drawn  out  period  of  hopelessness; 
the  enormous  risk  of  infection  to  the  other  members  of  the 
family,  and  the  cumulative  probability  of  disease  from 
exposure,  starvation,  and  discouragement;  all  of  these  things 
can  be  put  truthfully  into  a  picture  so  harrowing  that  even 
the  hardened  medical  man  can  scarcely  face  it.  Time  for- 
bids me  to  dwell  upon  it. 

Finally,  we  must  face  this  fact:  the  tendency  of  this 
disease,  of  course,  is  to  develop  in  unhygienic  conditions, 
in  the  congested  districts;  the  tendency,  moreover,  and  this 
is  a  most  pathetic  fact,  is  for  the  disease  which  developes 
outside  of  those  districts,  of  necessity  to  drift  into  those 
districts.  The  result  is  that  as  long  as  we  have  congested 
districts  undealt  with  in  this  direction,  so  long  shall  we  have 
a  focus  of  tuberculosis  from  which  "uall  emanate  constantly 
and  unavoidablv  the  infective  germ  which  scatters  itself 


2i6  HENRY     BAIRD     FAVILL 

through  evety  avenue  of  cit}^  life  and  into  every  spot,  no 
matter  how  hygienic,  estabhshing  relations  one  way  and 
another  with  every  level  of  society.  A  good  neighborhood, 
good  household,  good  living  conditions,  and  wholesome 
occupation,  are  no  protection  against  this  factor  in  the 
question. 

Remember  that  I  have  said  a  tubercular  patient  in  any 
stage  need  be  no  menace  to  people  living  in  the  same  room, 
and  remember  also  that  a  tubercular  patient  in  an  advanced 
stage,  uninstructed  and  unsupervised,  is  more  or  less  a 
menace  to  everyone  who  lives  within  reach  of  the  wind  that 
blows  past  his  door. 

Something  must  be  done  about  it.  The  workers  in 
this  field  know  no  discouragement.  They  have  seen  three 
things:  that  the  dangerous,  advanced  consumptive  can  be 
taught  not  to  endanger  anyone,  that  consumptives  taken 
very  early  can  in  a  great  preponderance  of  cases  be  saved, 
and  that  the  members  of  the  community  particularly  ex- 
posed to  danger  can  be  effectively  protected.  All  this  they 
have  seen  and  the  effect  upon  the  aggressive  force  is  to  in- 
spire them  with  courage. 

There  is  a  way  to  do  it.  The  problem  is  simple  of 
statement:  First,  get  into  immediate  contact  with  the 
situation,  the  sick  and  their  households.  Second,  develop 
the  simplest  practicable  method  for  dealing  with  the 
various  types.  Third,  bring  to  bear  upon  the  situation,  as 
it  exists,  intelligence  and  money,  and  the  problem  is  on  the 
way  to  solution. 

The  work  will  take  a  generation  or  two  or  three,  but 
whatever  it  takes  it  will  have  more  than  paid  at  every  step. 


M  E  D  T  r  INK      AND      V  IJ  15  L  I  f      11  V.  A  F.  T  JI  217 


Delivered,   I'^ifty-sc^vciil  li   Amiiial   Session  of  tlic   Illinois  State  Medical 

Society,  May  21-23,  I9"7- 
Printed,  Illinois  Medical  Journal,  August,  1907. 

SOCIAL  ASPECTS   OF   TUBERCULOSIS 

THE  work  in  tlic  tuberculosis  field  naturally  divides 
itself  into  three  categories  more  or  less  distinct: 
first  the  development  of  the  scientific  facts  under 
the  guidance  of  pathologists,  coupled  with  clinical  effort 
appropriating  and  adapting  for  therapeutic  purposes  all 
of  the  accumulating  data. 

When  one  considers  what  has  been  accomplished  since 
1880  in  this  direction,  it  seems  as  though  we  were  surely- 
approaching  a  fundamental  conception  of  the  strife  between 
the  parasite  and  the  organism.  For  practical  purposes  we 
certainly  have  an  abundance  of  valuable  data.  It  must  be 
borne  in  mind,  however,  that  the  whole  subject  of  the 
reaction  of  the  human  organism  to  the  hostile  parasite  is 
under  careful  investigation  and  review,  and  that  our  con- 
ception of  tuberculosis  will  have  to  follow  the  developments 
of  knowledge  in  respect  to  these  deep  physiologic  problems, 
perhaps  to  the  point  of  entirely  altering  what  is  now  reason- 
ably fixed  scientific  dogma.  Our  great  advances  in  thera- 
peutics have  not  been  entirely  due  to  this  increase  of  accu- 
racy in  our  scientific  concept. 

In  certain  respects  a  knowledge  of  the  true  nature  of 
tuberculosis  has  been  an  aid  in  the  combat  against  it  as  a 
general  proposition,  but  the  present  stage  of  therapeutic 
efficiency  is  the  result  of  scientific  effort,  clinical  rather  than 
pathologic. 

Therapeutics  is,  as  it  has  always  been,  essentially  em- 
piric, and  w^hether  we  shall  ever  see  the  time  when  it  is  not 
so  is  conjecture.  Beyond  all  question  the  plan  of  treat- 
ment now  approved  is  the  result  of  painstaking  and  deter- 
mined experiment,  based  upon  close  observation  and  -wide 


2i8  HENRY     BAIRD     FAVILL 

interpretation  of  strictly  clinical  facts.  Wonderful  as  the 
improvement  has  been  in  the  method  of  procedure,  it  is  far 
less  the  result  of  scientific  acumen  than  it  is  the  fruit  of  deter- 
mined and  devoted  service  on  the  part  of  physicians  more 
humanitarian  than  technically  scientific. 

So  great  has  been  the  growth  in  recognition  of  the  tre- 
mendous importance  of  tuberculosis  to  mankind  on  the 
part  of  the  medical  profession,  and  cooperation  with  them 
on  the  part  of  the  people  at  large,  that  a  wave  of  resolution 
to  combat  the  evil,  unprecedented  in  the  history  of  man- 
kind, is  sweeping  over  the  world.  The  sense  of  obligation 
to  those  whose  life  conditions  make  them,  on  the  one  hand, 
unduly  exposed  and,  on  the  other,  hopelessly  restricted  in 
their  ability  to  put  forth  individual  correction,  has  grown 
to  the  point  of  imperative  impulse  and  is  driving  the  public 
on  to  some  beneficial  result. 

As  a  phase  of  this  movement  comes  the  necessity  for 
organization,  and  the  second  category  into  which  the  work 
falls  is  that  of  systematic  propaganda.  Into  this  field  drift 
the  laborers  who  have  talent  and  taste  for  organization, 
and,  although  it  is  obvious  that  a  great  deal  of  effort  might 
be  frittered  away  on  the  mere  framework  of  such  a  struc- 
ture, and  although  it  is  easy  to  lose  sight  of  the  real  object 
in  the  interest  as  to  plan,  machinery,  office-holding,  and 
public  prominence,  it  is  yet  to  be  borne  in  mind  that  the 
comprehensive  achievement  in  this  warfare  can  not  take 
place  without  the  highest  development  toward  perfection 
of  this  same  machinery.  It  must  not  be  forgotten,  however, 
that  this  machinery  is  not  only  not  strictly  medical  machin- 
ery, but  that  it  is  only  casually  and  to  a  limited  extent  at 
all  a  medical  matter. 

However  possible  it  may  be  for  the  profession  to  organize 
and  develop  these .  instrumentalities  of  propaganda,  the 
product  of  their  activities  is  bound  to  be  of  much  broader 
relationship.  After  all  has  been  determined  that  can  be 
by  the  medical  scientist,    after  all  the  organization  plan 


M  10  D  J  C  I  N  Iv      AND      I'  U  U  I.  I  (       III,  Al.'IIf  219 

that  it  is  dcsirfihlo  to  outline  has  been  reahzed,  there  still 
remains  the  third  prohlcm,  how  to  bring  to  bear  upon  the 
masses  of  peo])lc  in  llic  world  1h(;  knowledge  and  facilities 
available  for  their  succor  in  their  dire  conditions.  How 
to  generalize,  for  the  benefit  of  the  race,  specific  knowledge, 
how  to  distribute  to  the  many  the  special  advantages  form- 
erly available  only  to  the  few,  is  a  problem  in  sociology, 
and  that  means  not  only  a  task  which  can  not  be  solved  by 
physicians  as  such,  but  which  can  be  participated  in  by 
them  only  in  so  far  as  they  make  themselves  sociologists. 

According  to  our  present  light,  the  technique  of  manage- 
ment in  any  given  case  of  tuberculosis  is  reasonably  well 
settled  so  far  as  the  method  of  election  is  concerned,  but 
what  may  be  determined  as  the  minimum  in  point  of  facil- 
ities, cost,  and  attention,  maintaining  at  the  same  time 
efficiency,  is  as  ^'■et  more  or  less  open  to  question.  The 
present  conception  of  a  perfect  regime,  whether  prophy- 
lactic or  curative,  in  spite  of  its  simplicity  of  principle,  is 
exceedingly  complex  in  its  broader  relations  as  to  practi- 
cability. 

It  is  perfectly  obvious,  however,  that  the  success  of  any 
movement,  considered  from  the  community  standpoint,  is 
going  to  be  limited  by  considerations  of  feasibility.  Not 
only  must  the  social  conditions  in  which  the  community 
reposes  be  molded,  adapted,  and  perfected,  but  the  deter- 
mination as  to  the  essentials  of  management  of  this  subject 
must  proceed  to  the  fullest  possible  extent  in  the  direction 
of  simplification. 

The  problem  of  combating  tuberculosis  in  communities 
presenting  comparatively  small  groups  of  indigent  families 
is  really  simple.  It  requires  nothing  more  than  a  deter- 
mined, intelligent  effort  on  the  part  of  the  forces  working 
to  that  end.  The  sparseness  of  population,  the  accessibility 
of  open  spaces,  the  comparative  cheapness  of  supplies,  and 
the  lack  of  enormous  "group  inertia"  pertaining  to  masses 
of   people,    all    offer    features    of    feasibility    and    ease    of 


220  HENRY     BAIRD     FAVILL 

management  which  grow  progressively  less  as  the  mass  in 
question  becomes  more  dense. 

It  is  only  necessary  to  contrast  the  problem  presented 
by  one  city  tenement,  with  such  conditions,  to  see,  at  a 
glance,  the  task  is  inexpressibly  greater  in  the  large  city. 
It  is  not  merely  a  question  of  larger  numbers;  it  is  a  question 
of  absolutely  different  conditions  of  living,  involving  not 
only  industrial  pursuits,  fixed  styles  of  habitation,  and  utter 
absence  of  open-air  facilities,  but  it  involves  that  great  and 
intangible  tenacity  of  choice  found  in  the  masses  of  people, 
whereby  they  apparently  prefer  conditions  of  discomfort 
and  squalor  to  conditions  of  more  sanitary  character,  which 
is  not  at  all  a  matter  of  intelligent  choice  upon  their  part, 
but  a  fixed,  underlying,  psychologic  factor  recognized  by  all 
sociologic  observers  in  their  efforts  to  institute  even  prac- 
ticable reform. 

These  facts  make  the  city  problem  complex  to  the  last 
degree  and  yet  the  more  imperative,  for  by  no  possibility 
can  the  interests  of  the  intelligent  and  amenable  of  the  body 
politic  be  safeguarded  without  reckoning  with  and  master- 
ing these  lower  elements  in  the  community. 

The  problem  is  not  a  mere  question  of  saving  the  lives 
of  so  many  poor  and  ignorant;  it  is  the  problem  of  rooting 
out  and  exterminating  conditions  which  continue  to  breed 
disease  and  to  serve  as  a  focus  from  which  dissemination  to 
the  entire  body  is  inevitable.  So  far  as  the  determination 
as  to  the  greatest  possible  simplicity  goes,  it  is  as  desirable 
for  the  small  group  as  for  the  large  one,  but  the  methods 
whereby  the  warfare  should  be  carried  on  are  utterly  dif- 
ferent in  the  two  cases. 

The  greatest  advance  toward  practical  solution  has  come 
with  the  recognition  of  the  fact  that  radical  climatic  change 
is  not  an  essential.  It  has  been  demonstrated  over  and 
over  again  that  the  arrest  and  cure  of  a  tubercular  process 
is  entirely  practicable  in  almost  any  climatic  conditions. 
Let  us  not  waste  time  over  a  discussion  as  to  whether  there 


M  li  I)  1  ('  I  N  l<:      AND      IMJ  H  I.  J  (       III:AI,'III  22  r 

is  a  better  or  worse  climatie  setting.  The  fact  is,  that 
radical  climatie  change  is  impossible  for  any  but  a  tiny 
majority  of  the  i)a,Lien1s,  and  is,  therefore,  to  be  set  aside 
as  of  no  practical  importance  in  the  light  of  our  recent 
experience.  The  same  can  not  be  said,  however,  as  to  the 
relative  necessity  for  clean  air.  What  a  pure  air  is,  is  not 
easy  to  state,  but  that  pure  air  is  better  than  polluted  air 
is  beyond  question,  and  that  the  way  to  offset  the  impurity 
of  city  air  is  by  providing  unlimited  access  to  such  air  as 
there  is,  is  also  clear. 

It  is  obvious  that  under  present  conditions,  at  least, 
most  of  the  tubercular  poor  have  got  to  be  cared  for  under 
some  conditions  other  than  hospitals  or  sanitariums  afford. 
There  is  no  immediate  prospect  that  such  facilities  will  be 
offered  nor  has  the  day  yet  arrived  when  incipient  patients 
from  these  classes  could  be  induced,  as  a  rule,  to  go  away 
for  sanitarium  treatment.  All  are  agreed  that  tuberculosis 
must  be  met  where  it  is  and  that  some  conditions  must  be 
established  which  will  accomplish  adequately  two  things: 
first,  education  of  the  individual  as  to  his  needs  and  possi- 
bilities; second,  an  opening  for  him  through  which  these 
can  be  attained. 

Although  as  an  industrial  question  the  living  wage  and 
its  bearing  upon  food  is  of  paramount  importance,  and  for 
that  reason  becomes  the  corner-stone  of  any  structure  which 
may  be  permanent,  it  is,  after  all,  true  that  food,  irrespective 
of  wages,  is  the  most  possible  element  to  supply  through 
philanthropic  effort.  This  really  is  a  mere  question  of 
money  and  sufficiently  intimate  supervision. 

The  question  of  habitation  presents  the  real  difficulties 
in  the  matter.  Though  this  has  a  distinct  relation  to  living 
wage  as  a  broad  proposition,  it  is  not  as  susceptible  of 
adjustment  and  solution  by  far  as  the  food  question.  The 
individual  child,  for  example,  can  be  fed  quite  irrespective 
of  the  family  feeding.  It  is  rare  that  it  can  be  practically 
housed  at  a  distance.     It  is,  however,  true  that  such  an 


222  HENRY     BAIRD     FAVILL 

individual  in  the  family  must  be  housed  differently,  even 
though  in  the  same  habitation,  and  how  to  create  out  of 
a  tenement  mess  a  hygienic  corner  is  the  great  problem 
involved  in  this  matter. 

The  difficulties  are  less  in  cases  which  are  sufficiently 
early  or  mild  to  be  ambulatory.  The  necessity  for  a  com- 
bination of  perfect  rest  and  fresh  air,  which  modern  thera- 
peutics recognizes,  taxes  the  ingenuity  of  the  physician 
working  in  this  field,  to  the  utmost.  It  is,  however,  also 
true  that  even  these  forlorn  conditions  can  be  combated 
and  in  a  large  measure  overcome  by  sufficient  determination. 

Again  let  me  call  your  attention  to  the  necessity  for 
simplification  to  the  utmost  degree  of  our  demands  as  to 
therapeutic  necessities.  Once  we  have  determined  what 
are  the  essentials,  and  have  further  determined  that  those 
essentials  can  be  attained  in  conditions  presenting  a  certain 
minimum  of  facilities,  we  have  established  a  unit  of  thera- 
peutic procedure.  This  may  be  regarded  as  a  medical 
determination.  The  problem  of  installing  efficiently  that 
unit  in  the  thousands  of  spots  where  tuberculosis  exists,  is 
a  problem  for  the  sociologist.  The  machinery  necessary 
to  achieve  this  must  be  the  outgrowth  of  years  of  effort 
from  countless  workers  approaching  from  all  directions, 
but  focusing  upon  this  point.  The  foregoing  brief  sugges- 
tions bear  particularly  upon  the  treatment  of  those  actually 
involved  in  the  disease. 

The  greatest  problem  of  the  future  in  the  tuberculosis 
crusade,  because  the  one  fraught  with  the  most  possibilities, 
is  the  problem  of  prophylaxis.  What  is  to  be  done  to  ren- 
der the  chance  of  infection  less?  Here  we  encounter  the 
intricacies  of  the  social  structure  manifested  to  a  highly 
multiplied  degree.  With  those  diseased  we  are  dealing  with, 
after  all,  a  fraction  of  the  community.  For  the  purpose  of 
influencing  those  not  diseased,  we  are  dealing  with  condi- 
tions involving  practically  the  entire  mass  of  people.  No 
one   can  know    what   individual   is    especially   in    need   of 


M  l<:  I)  I  C  J  N  !•:      AND      I'  11  I'.  1,1  C       III-:  A  I,  I    II  223 

protection.  No  one  can  at  present  hyjjothesize  as  to  the 
susceptibility  or  ])robabiltty  of  infection.  The  nece.ssary 
prophylaxis  must  l)c  universal  ami,  of  course,  opens  the 
whole  question  of  the  physical  habits  of  a  people. 

In  order  materially  to  influence  this  question,  we  find 
ourselves  plunged  at  once  into  the  depths  of  difficulty 
presented  by  the  conditions  of  the  industrial  classes.  The 
well-to-do,  no  matter  how  unhygienically  disposed,  are 
nevertheless  to  be  reached  by  enlightenment  and  are  not 
hopelessly  barred  from  the  fruits  thereof,  but  conditions 
of  living  which  stand  in  conflict  with  hygienic  possibility, 
and  which  are  the  result  of  fixed  industrial  and  social  insti- 
tutions, must  be  modified  to  whatever  extent  is  necessary 
before  this  achievement  in  preventive  medicine  can  be 
conspicuous. 

In  common  with  all  questions  involving  the  amelioration 
of  conditions  in  which  the  industrial  classes  live,  and  partic- 
ularly involving  the  increased  enlightenment  of  the  whole 
people,  this  matter  must  be  approached  most  effectively 
through  the  children.  When  we  consider  the  three  factors 
which  are  of  primary  weight  in  this  warfare,  this  will  be 
manifest. 

We  must  first  have  such  habitation  conditions  as  will 
not  make  the  infection  of  the  children  an  inevitable  result. 
Conditions  must  be  found  whereby  children  can  have  a 
certain  protection  from  intra-family  transmission.  This 
involves  not  only  better  habitations,  but  a  different  con- 
ception of  domestic  management,  and  this  can  be  achieved 
only  by  a  strong  pressure  in  behalf  of  the  children. 

Second  comes  the  spread  of  intelligence.  It  is  ver}^  well 
recognized  that  in  sociologic  effort  extending  in  its  scope  and 
prospect  over  a  long  period  of  time,  the  point  of  advantage 
and  attack  is  the  child,  and  so  it  is  that,  in  looking  forward 
a  generation  for  substantial  results,  we  are  quite  justified 
in  pinning  our  faith  as  to  promise  of  those  results  upon  the 
education  of  the  child  now  coming  up.     Not  only  is  the 


224  HENRY     BAIRD     FAVILL 

promise  of  mature  intelligence  through  education  of  the 
child  justified,  but  right  along  even  during  childhood  years 
these  little  citizens  exercise  an  immeasurable  influence  upon 
family  life. 

But  above  and  beyond  this  is  the  third  consideration. 
No  problem  is  greater  before  the  world  to-day  than  that 
of  instilling  the  essence  of  hygienic  living.  Assuming,  if 
we  may,  for  the  moment,  all  our  desiderata  and  all  of  the 
necessary  physical  conditions  and  possibilities  as  achieved, 
until  the  genius  of  the  people  has  been  reclaimed  from  the 
habitation  type  and  restored  to  the  out-of-door  and  air- 
loving  type,  this  question  will  not  be  solved.  While  recog- 
nizing certain  apparently  contradictory  facts,  such  as  the 
extreme  susceptibility  of  savage  tribes  to  tuberculosis  and 
the  relative  insusceptibility  of  habitation  tribes  of  our  city 
dwellers,  due  to  what  seems  to  be  an  acquired  immunity, 
one  is  nevertheless  justified  in  declaring  that  habitation  life 
is  essentially  an  artificial  condition  which  must  be  met  by 
appropriate  corrections. 

The  notion  of  immunity  incident  to  prolonged  and  in- 
tense exposure  to  infections,  may  have  a  scientific  interest, 
but  even  if  it  be  sound,  as  a  means  of  ridding  the  world  of 
tuberculosis  and  of  making  life  safe  and  agreeable,  it  is  not 
to  be  considered.  The  love  of  the  out-of-door  life,  irrespec- 
tive of  its  elevating  and  emancipating  effects  from  a  mental 
or  moral  standpoint,  is  perhaps  the  greatest  safeguard  of 
the  people.  In  no  way  can  such  life,  taste,  and  habit  be 
inculcated  without  affording  opportunity,  and  we  come 
immediately  face  to  face  with  what  is  thought  to  be  simply 
a  civic  problem,  namely  the  establishment  of  out-of-door 
space,  accessible  to  the  public  and  offering  such  facilities  and 
attractions  as  will  lead  the  youth  of  the  community  to 
incorporate  into  its  daily  life  a  measure  of  its  experiences. 

The  enlargement  of  the  plans  of  outing,  of  out-of-door 
schools,  of  playgrounds,  of  supervised  gymnasiums  and  all 
of  the  activities  which  can  be  brought  to  bear  upon  the 


M  l<:  I)  I  C  I  N  I<:      AND      IM:|{LI(        III.  a  1,111  225 

development  of  the  younj^,  arc  of  fundamental  itiTportance 
in  this  broad  conception. 

When  we  stop  to  consider  that  tuberculosis  is  only  to 
be  cured  in  its  incipiency,  that  whenever  it  is  established 
and  progressive  it  is  not  only  to  the  individual  a  certain 
destruction,  but  to  the  contingent  community  a  menace, 
and  when  we  consider,  in  addition,  the  probability  that  an 
enormous  part  of  the  infection  takes  place  in  childhood,  it 
leads  us  inevitably  to  the  conviction  that,  from  a  public 
and  sanitary  viewpoint,  efiforts  should  be  concentrated  upon 
prevention. 

The  few  suggestions  foregoing,  it  seems  to  me,  unerr- 
ingly point  to  the  conclusion  that  the  successful  war  upon 
tuberculosis  is  a  community  matter  rather  than  a  medical 
matter,  and  that,  however  great  our  duty  may  be,  as  enlight- 
ened and  expert  molders  of  public  opinion,  we  must  unfetter 
ourselves  from  our  special  and  scientific  restrictions.  We 
must  enlarge  our  view  and  distribute  our  energies,  in  so  far 
as  we  hope  to  be  effective,  into  lines  of  sociologic  research 
and  effort,  and  endeavor  not  only  to  become  wise  critics 
of  method,  but  earnest  cooperators  in  the  work  of  social 
evolution. 


226  HENRY     BAIRD     FAVILL 


Delivered,  Playground  Association  of  America,  June,  1907. 
Printed,  Charities  and  the  Commons,  August  3,  1907. 

PLAYGROUNDS  IN  THE  PREVENTION  OF 
TUBERCULOSIS 

IN  attempting  to  estimate  the  value  of  the  achieve- 
ments which  now  and  hereafter  are  to  be  accredited 
to  the  Playground  Association  of  America  in  their 
bearing  upon  the  great  problem  of  health,  and  more  speci- 
fically upon  the  distressing  and  imperative  questions  of 
tuberculosis,  one  is  led  to  a  simple  subdivision  of  territory 
into  parts  quite  separable  in  theory  and  infinitely  inter- 
woven in  fact. 

We  are  in  the  habit  of  speaking  of  the  treatment  or  cure 
of  tuberculosis  on  the  one  hand  and  the  question  of  preven- 
tion of  tuberculosis  on  the  other.  The  logic  of  the  situa- 
tion would  seem  to  suggest  that  as  a  social  proposition  it 
were  worth  while  to  concentrate  effort  upon  the  ways  and 
means  for  prevention.  As  a  practical  proposition,  however, 
the  foundations  of  prevention  are  only  to  be  considered 
secure  when  the  question  of  treatment  or  management  of 
individuals  already  diseased  is  adequately  met. 

The  war  against  tuberculosis  is  being  combatted  by 
many  forces  approaching  from  various  directions.  Proba- 
bly no  group  can  carry  a  complete  work  and  no  intelligent 
effort  should  be  considered  superfluous.  There  are  three 
general  lines  of  effort. 

Men  of  science  are  pursuing  with  intensity  the  ultimate 
facts  as  to  the  nature  of  the  disease,  and  very  significant  and 
encouraging  data  are  rapidly  accumulating.  Whatever  is 
thus  offered  is  being  eagerly  adapted  for  the  practical  pur- 
pose of  relief  and  protection,  and  the  scientific  status  of  this 
matter  must  be  considered  thoroughly  satisfactory. 

It  is  to  be  remembered,  however,  that  the  exact  state- 
ment of  scientific  dogma  must  vary  as  observations  and 


M  i<:  I)  I  (  I  N  I-:    AND    im;i'.  i,i(      iii-,  ai.iii        227 

demonstrations  multiply,  and  that  not  only  must  we  anti- 
cipate great  change  in  the  scientific  theory  j^ertaining  to 
this  subject,  but  we  must  continually  guard  against  traveling 
paths  which  are  too  closely  contingent  upon  accuracy  of  a 
present  theory,  and  on  the  other  hand  must  aim  to  pursue 
lines  which  are  obviously  sound  in  the  light  of  practical 
experience. 

Fortunately  our  status  as  to  treatment  has  not  been 
determined  by  theoretical  considerations  to  any  such  de- 
gree as  to  make  it  particularly  sensitive  to  changes  of 
dogma.  It  has  rather  been  the  outgrowth  of  experience  and 
wise  interpretation  of  accurate  observation  and  clinical 
results.  Our  wonderful  advances  have  been  far  less  the 
result  of  scientific  development  than  the  reward  of  deter- 
mination and  devotion  on  the  part  of  physicians  whose 
humanity  has  led  them  to  exhaustive  and  persistent  effort. 
So  signal  has  been  the  demonstration  of  great  possibilities 
in  this  medical  field,  that  the  whole  world  has  been  agitated 
and  has  begun  to  participate  in  the  work  of  establishing 
sanitary  foundations  upon  which  shall  grow  an  immunity 
from  this  unspeakable  scourge. 

Recognition  of  the  dire  distress  of  those  whose  condi- 
tions of  life  surround  them  necessarily  wdth  danger,  and  of 
their  pitiable  inability  to  protect  themselves  by  personal 
effort,  has  long  existed  and  it  has  been  supplemented  by  a 
distinct  hope  that  something  can  be  done  to  mitigate  such 
conditions.  Out  of  these  two  factors  has  grown  a  moral 
awakening  amounting  to  an  imperative  impulse. 

In  bringing  to  an  effective  point  this  public  movement, 
the  second  class  of  workers  comes  of  necessity  into  evidence. 
Organization  and  propaganda  are  the  functions  to  which 
this  class  must  devote  itself,  and  it  is  inspiring  to  note 
the  tremendous  development  of  organized  relief  machinery 
which  has  come  into  existence.  Although  as  a  rule  these 
efforts  arise  with  the  medical  profession,  it  must  be  borne 
in  mind  that  they  are  only  incidentally  medical  matters, 


228  HENRY     BAIRD     FAVILL 

and  that  to  regard  them  as  such  would  be  at  the  outset  to 
minimize  their  achievements. 

WTiile  the  medical  profession  is  outlining  the  technical 
facts  upon  which  the  campaign  must  be  founded,  there  still 
remains  a  third  problem,  magnificent  in  its  proportions,  how 
to  bring  the  masses  of  people  in  the  world  needing  protection 
within  the  circle  of  intelligence  and  under  the  ministration 
of  facilities  adequate  to  their  dire  necessities. 

How  to  make  available  for  general  application  a  technical 
fact  which  from  its  conditions  demands  material  resources 
possessed  by  a  tiny  minority  of  the  world,  is  a  problem  in 
sociolog>^  to  which  physicians  can  contribute  nothing  except 
from  the  standpoint  of  sociologic  adventure. 

We  feel  reasonably  satisfied  with  our  ability  to  cope  with 
certain  phases  of  tuberculosis  when  we  are  given  facilities, 
but  in  the  general  and  public  aspect  of  the  matter  we  have 
still  before  us  to  determine  what  is  the  minimum  require- 
ment which  shall  still  be  possible  to  prove  efficient. 

What  seems  so  simple  in  modern  management  of  tuber- 
culosis, as  a  process  for  practical  application  to  the  masses 
is  beyond  measure  complex. 

We  cannot,  however,  escape  the  necessity  of  establishing 
conditions  of  feasibility  before  our  efforts  can  have  any 
prospect  of  success.  Two  lines  of  effort  must  proceed 
together.  On  the  one  hand,  all  ingenuity  will  have  to  be 
exercised  to  mold,  modify,  and  adapt  living  conditions  with 
reference  to  these  features  of  treatment,  and  on  the  other, 
therapeutic  demands  must  be  simplified  to  the  utmost 
justifiable  degree. 

Tuberculosis  in  small  communities  of  people,  having 
comparatively  few  poor  and  being  reasonably  well  separ- 
ated, is  not  at  all  an  intricate  problem.  It  requires  some 
money,  determination,  and  systematic  pursuit.  When  one, 
however,  undertakes  to  estimate  the  problem  presented  by 
city  conditions  upon  such  a  basis,  it  is  immediately  obvious 
that  the  problem  is  not  simply  one  of  multiplied  numbers, 


M  J-;  I)  I  (    1  N  IC      y\  N  I)      IMJIJLIC     il  E  A  L  IH  229 

but  that  there  are  features  distinetive  of  "group"  condi- 
tions, which  in  the  field  of  socio! ogic  effort  present  more 
or  less  common  perplexities.  Not  only  is  it  difficult  to  pro- 
tect the  individual  against  the  mass  in  these  circumstances, 
but  it  is  almost  as  difficult  to  separate  the  individual  from 
his  peculiar  social  ])ropensitics,  without  at  the  same  time 
moving  the  mass  along  lines  which  it  tenaciously  resists. 
To  say  that  the  more  submerged  masses  prefer  squalor  and 
discomfort  would  be  beside  the  facts,  but  to  recognize  the 
tenacity  with  which  they  cling  to  the  same,  as  a  feature  of 
"group"  existence,  is  absolutely  necessary  before  the  com- 
bat therewith  can  have  any  promise. 

The  more  fixed  these  city  conditions  are,  the  more  abso- 
lute is  the  necessity  to  cope  with  them,  because  a  breeding 
ground  of  disease  will  always  be  found  in  the  centers  of 
dense  and  more  or  less  squalid  residence.  What  to  do  in 
these  discouraging  and  apparently  hopeless  conditions  is 
the  question  before  us.     It  is  reasonably  easy  of  statement: 

First,  so  to  provide  for  the  individuals  who  are  diseased 
beyond  the  chance  of  recovery  that  they  shall  be  com- 
fortable and  no  longer  a  menace  to  those  about  them. 

Second,  so  to  educate  those  whose  disease  is  sufficiently 
incipient  to  have  a  prospect  of  Tecovery,  that  they  may 
avail  themselves  of  the  facilities  offered  and  at  the  same 
time  offer  to  them  those  opportunities. 

Third,  so  to  restore  the  conditions  of  living  that  those 
not  yet  infected  or  in  whom  a  latent  infection  has  made  no 
headway  may  maintain  such  a  grade  of  physical  health  as 
to  protect  them  against  attacks  from  within  and  without. 

With  the  difficulties  of  dealing  with  those  already  dis- 
eased we  need  not  concern  ourselves  here.  It  is  enough 
that  we  recognize  them  as  greater  than  can  be  successfully 
overcome  inside  of  generations. 

With  the  third  consideration,  the  preservation  of  health 
in  those  thus  far  uninfected,  we  have  distinctly  to  deal  in 
any  broad  conception  of  this  playground  problem. 


230  HENRY     B  A  I  R  D     F  A  V  I  L  L 

I  believe  it  is  reasonably  established  that  social  vices, 
voluntary  or  circumstantial,  which  are  deeply  rooted,  can- 
not be  uprooted  except  through  continuous  and  systematic 
effort  covering  a  long  period  of  years,  and  to  the  correction 
of  which  contributory  factors  of  all  kinds  must  be  brought 
into  operation.  Practically  in  almost  all  such  questions 
the  hope  of  the  future  lies  in  the  children,  and  the  weight 
of  the  elements  which  must  be  considered  and  brought 
into  harmonious  constructive  operation  is  enormous. 

It  is  not  at  all  sufficient  that  the  children  be  protected 
during  their  helpless  years  from  danger;  they  must  be  fur- 
nished with  sturdy  disease-resisting  bodies.  The  problem 
of  tuberculosis  involves  a  deep  conviction  as  to  the  prin- 
ciples of  living  which,  even  though  it  can  be  inculcated  in 
their  youth,  will  be  as  rapidly  eradicated  by  their  contact 
with  their  elders,  unintelligent  and  fixed  in  habit,  unless 
their  knowledge  and  impulse  can  be  kept  alive  by  special 
advantages  and  inspirations. 

Side  by  side  with  the  development  of  intelligence  in  the 
child  must  come  the  magnifying  of  child  importance  in  the 
domestic  organization.  The  two  factors,  child  education, 
growing  into  mature  habit  and  belief,  and  child  importance, 
influencing  family  method  and  proportion,  if  they  could  be 
achieved  would  distinctly  advance  the  freedom  of  the  world 
from  the  tuberculosis  pall. 

If  we  accept  the  proposition  that  through  the  child  must 
come  the  great  advances  in  the  social  conditions  of  the 
race,  it  becomes  necessary  to  determine  with  some  degree 
of  certainty  the  lines  upon  which  child  influence  is  operative 
and  what  variations  in  its  influence  may  fairly  be  sought. 

It  is  scarcely  conceivable  that  mere  academic  instruction, 
even  supposing  that  it  could  amount  to  real  intelligence  in 
the  child,  could  be  of  much  weight  in  combatting  the  over- 
whelming influence  of  pernicious  environment.  It  is  not 
likely  that  the  full  training  of  a  child  in  the  practical  ways 
of  hygienic  life  as  an  individual,  would  have  markedly  great 


M  !<:  I)  I  c;  1  N  10    AND    lm;  ij  I.  J  c    III:  A  I.  I  II       23/ 

influence.  I  think  it  is  fair  to  assume  that  neither  of  these 
ends  could  be  accompHshed  by  itself,  and  hence  we  are 
forced  to  face  the  matter  as  related  in  some  way  to  mass 
influence,  which  may  fairly  be  expected  to  react  upon  the 
general  child  life  of  the  community. 

When  we  reflect  upon  the  economic  restrictions  surround- 
ing the  industrial  classes,  we  must  recognize  beyond  a  ques- 
tion the  difficulty  of  magnifying  child  importance  in  the 
family,  at  least  as  a  conscious  process  on  the  part  of  the 
family.  Instinctive  parental  solicitude  very  rapidly  wanes 
under  the  hard  conditions  of  existence,  and  unless  this  can 
be  fortified  by  far  reaching  and  powerful  counter  agents,  the 
child  will  continue  to  be  subordinate  to  almost  any  degree. 

I  think  it  would  be  agreed,  however,  that  given  any 
reasonable  opportunity,  the  natural  instinct  of  the  family 
is  to  cherish  the  child  and  provide  for  its  enlargement  of 
life  opportunities.  To  assume  indifference  fundamental  and 
unchangeable  on  the  part  of  even  the  low  and  ignorant,  with 
reference  to  the  prospects  of  offspring,  is  to  reckon  without 
the  most  potent  force  in  human  experience. 

How  then  is  this  primary  impulse  to  be  unfettered,  to 
the  end  that  child  importance  in  "group"  life  becomes  a 
dominating  idea  ?  By  what  means  is  it  possible  to  cultivate 
this  conception  of  relative  importance?  How  can  the  vari- 
ous factors  concerned  be  so  coordinated  that  they  shall 
move  harmoniously,  even  though  slowly,  toward  a  dis- 
tinctly better  position? 

To  answer  these  questions  adequately'  would  be  to  solve 
the  problem  of  social  regeneration  in  anA'  and  perhaps  in 
every  direction.  The  difficulty  of  making  things  move  to- 
gether has  been  and  will  continue  to  be  the  incubus  upon 
all  reform  effort.  Not  to  recognize  this  necessity,  how- 
ever, would  be  to  ignore  the  perfectly  obvious,  and  beyond 
a  question  the  forces  working  toward  social  correction  must 
move  with  some  concentration  upon  this  point.  Organized 
cooperation  between  educators  on  the  one  hand,  combatters 


232  HENRY     BAIRD     FA  V  ILL 

of  child  labor  on  the  other,  molders  of  child  morality  on  this 
side,  protectors  of  child  vitality  on  that,  is  the  fundamental 
and  indispensable  desideratum  in  the  struggle. 

The  importance  and  significance  of  the  habits  of  life, 
illustrated  in  the  field  of  tuberculosis,  is  enormous.  The 
extent  to  which  this  penetrates  into  the  living  conditions 
of  the  entire  industrial  mass  is  overwhelming. 

One  glance  at  the  principles  of  treatment  of  incipient 
tuberculosis  opens  a  volume  of  reflection.  We  treat  tuber- 
culosis by  superabundance  of  fresh  air,  food,  and  rest. 
That  we  have  not  reached  exact  technical  definition  as  to 
the  amount  of  each  that  is  absolutely  necessary  goes  with- 
out saying,  but  that  the  adequate  supply  of  each  is  funda- 
mental to  the  cure  of  tubercular  disease  is  beyond  question. 

Need  one  stop  to  point  out  the  fact  that  the  principle 
which  underlies  the  treatment  or  cure  of  disease  must  be 
of  tenfold  importance  as  a  principle  underlying  proper  and 
protective  hygiene  ?  Do  we  concentrate  our  attention  upon 
abundance  of  fresh  air?  Instantly  we  are  confronted  by  the 
problems  of  habitation,  sanitation,  and  legal  regulation  of 
living  conditions. 

Do  we  turn  to  adequate  food?  Inevitably  we  include 
in  our  speculations  not  only  possible  source  of  supply,  but 
intelligent  utilization,  domestic  economy,  and  pride  of 
management.  Is  it  a  question  of  food  and  labor?  At  once 
there  opens  before  us  the  whole  territory  of  industrial  con- 
ditions, demands,  restrictions,  and  possibilities. 

It  is  probably  true,  however,  that,  from  the  stand- 
point of  the  practical  tubercular  sociologist,  these  factors 
are  not  equally  important.  In  this  country,  for  example, 
inadequate  food  is  not  an  extreme  condition.  In  the  very 
young  and  average  healthy  child,  sufficient  rest  is  not  so 
difficult  of  achievement. 

Of  the  three  elements  in  question,  air  is  the  important, 
predominating  condition.  "You  can  lead  a  horse  to  water 
but  you  can't  make  him  drink."     Has  it  ever  occurred  to 


MK  DICING      AND      IMJ  J'.  L  I  (        III.  A  LI   II  233 

you  that  the  ^reat  lack  in  tlic  world  is  not  lack  of  opportunity 
but  lack  of  disposition  to  make  use  of  it?  Have  you  prac- 
ticed medicine  in  the  country  and  had  to  discover  and  labor 
with  the  fact  that  no  one  is  so  much  house  surrounded  as  a 
country  girl;  that  no  one  is -so  utterly  unwilling  to  take 
normal  physical  exercise  in  the  open  air;  that  no  one  is  so 
likely  to  utterly  scorn,  as  food,  milk,  cream,  and  eggs? 

I  cite  this  as  a  signal  example  of  the  failure  of  opportunity 
to  carry  the  uninstructed  along  lines  of  hygienic  living.  It 
is  unnecessary  at  this  j^oint  to  question  why,  but  it  is  neces- 
sary to  reiterate  em])hatically  that  simply  furnishing  facil- 
ities for  wholesome  living  is  not  a  guarantee  of  a  wise  or  even 
ordinarily  healthful  employment  of  them. 

From  the  standpoint  of  tuberculosis  under  our  present 
light,  one  thing  must  be  accepted  as  fundamental.  To  as 
great  an  extent  as  possible  the  out-of-door  type  of  life  must 
be  substituted  for  the  habitation  type.  It  is  unnecessary 
to  argue  all  the  difficulties  involved  in  this,  or  to  hesitate 
in  the  face  of  the  industrial  restrictions  which  stand  in  the 
way  of  its  ideal  accomplishment.  It  is  not  necessary  that 
the  reform  in  type  of  life  be  absolute,  but  it  is  necessary  that 
it  be  so  pronounced  that  the  conditions  of  hygienic  living 
shall  be  established  to  a  degree  sufficient  to  ofifset  the  present 
encroachment  of  vicious  in-door  existence. 

I  waive  at  this  point  all  discussion  of  the  fact  that 
years  and  generations  of  life  in  densely  peopled  and  un- 
sanitary conditions  seem  to  have  produced  an  immunity 
against  tuberculosis.  Equally  I  waive  the  discussion  of  the 
interesting  fact  that  the  savage  races  are  enormously  over- 
susceptible  to  tuberculosis.  Those  are  deep  ph^^siologic 
and  ethnologic  problems  which  are  more  or  less  beside  the 
question. 

As  a  practical  movement  in  our  present-day  struggle, 
the  fact  is  not  to  be  gainsaid  that  proper  fresh  air  experi- 
ence as  a  daily  factor  in  life  is  the  most  important  single 
element  in  this  whole  question.     To  accomplish  anything 


234  HENRY     BAIRD     FAVILL 

in  this  direction  involves  a  great  deal  more  educative  effort 
than  is  generally  realized.  The  public  is  liable  to  feel  that 
it  has  done  its  duty  when  it  has  established  a  wise  tene- 
ment law,  when  it  has  furnished  an  abundance  of  parks, 
when  it  has  dotted  the  community  with  playgrounds.  As 
a  matter  of  fact,  when  all  that  has  been  done,  the  surface 
of  this  ground  has  only  been  scratched. 

The  problem  is,  and  will  continue  to  be,  how  to  im- 
plant in  the  human  race,  living  under  modern  social  con- 
ditions and  particularly  under  industrial  restrictions,  such 
a  hunger  for  air  as  will  force  it  to  take  advantage  of  facil- 
ities which  may  exist.  Again  and  again  I  shall  reiterate  this 
principle,  for  until  it  is  recognized,  until  effort  shall  be  ex- 
pended in  that  direction,  our  most  elaborate  contributions 
in  the  direction  in  which  we  are  to-day  engaged  will  be  of 
small  value. 

The  child  who  prefers  to  sit  huddled  up  in  the  corner 
reading  a  book,  is  an  abnormal  product  of  civilization  and 
has  as  distinct  a  vice  to  overcome  as  has  any  child  with 
any  degree  of  moral  obliquity.  The  family  whose  physical 
discomforts  lead  it  to  crave  the  immediate  comfort  of  warm 
air,  no  matter  how  polluted,  and  whose  economic  necessi- 
ties make  it  necessary  to  exclude  the  external  air,  is  inex- 
pressibly more  the  proper  object  of  state  intervention  than 
if  it  were  being  poisoned  by  food,  or  drug,  or  alcohol. 

No  one  with  experience  will  deny  that  these  conditions 
in  one  walk  of  life  or  another  exist.  We  are  altogether  too 
likely  to  conclude  that  they  need  to  exist. 

Experience  shows  that  it  is  not  difficult  to  teach  a 
tubercular  patient  to  sleep  comfortably  and  even  eagerly  in 
the  open  air  under  conditions  most  rigorous.  Such  edu- 
cation, however,  is  in  the  form  of  special  pressure  growing 
out  of  a  recognition  of  great  danger  and  a  consequent 
willingness  to  cooperate  in  its  avoidance. 

Experience  will  show  that  to  educate  a  whole  family, 
who  are  not  under  the  pressure  of  threatening  death,  to 


MEDICINE     AND      f  U  li  LI  C     IlIiALTU  235 

sleep  under  these  life-giving  conditions,  is  fraught  with  the 
utmost  difficulty,  yet  it  is  safe  to  say  that,  with  compara- 
tively minor  change  in  the  habits  of  living,  an  enormous 
gain  upon  the  tuberculosis  plague  could  be  made  by  that 
simple  device. 

Protection  of  the  child  must  be  the  watchword  under 
which  this  reform  will  be  achieved.  The  ideal  of  a  healthy 
body,  the  obligation  to  protect  the  child  in  its  susceptible 
years,  the  willingness  to  sacrifice  for  the  child  in  material 
ways,  have  to  come  as  the  foundation  for  general  reorgani- 
zation. 

The  scope  of  the  playground  movement  broadens 
enormously  at  this  point.  To  provide  generously  the  open 
spaces  necessary  to  carry  on  the  work  is  obviously  the  first 
duty.  To  regard  this  work  when  done  as  an  end  accom- 
plished, is  scrupulously  to  be  avoided.  To  learn  to  regard 
the  playground  as  an  elementary  means  to  a  very  great 
end,  must  be  the  object  of  our  propaganda. 

The  question  of  playgrounds  as  a  mere  matter  of  ac- 
quiring territory  is  really  very  simple.  The  utility  of  the 
playgrounds  in  their  broad  relations  will  stand  or  fall  upon 
the  method  of  their  administration.  To  those  well  versed 
in  the  subject  this  observation  is  unnecessary  and  perhaps 
trite.  To  the  mass  of  people  w^ho  are  really  anxious  that 
there  should  be  playgrounds  it  will  be  a  more  or  less  new 
conception.  Nothing  is  more  barren  than  a  playground 
which  is  not  administered  either  by  competent  manage- 
ment or  by  the  versatile  initiative  of  experienced  players. 
Nothing  is  more  inspiring  than  the  responsive  participation 
of  children  in  purposeful  play.  But  beyond  these  features 
which  touch  so  deeply  the  love  of  children  that  pervades 
the  human  race,  there  rests  upon  the  playground  organi- 
zation a  deep  and  imperative  duty:  —  to  make  the  play- 
ground one  of  the  factors  in  the  reorganization  of  social 
method  which  shall  offset  the  deteriorating  viciousness  of 
modern  habitation  life. 


236  HENRY     BAIRD     FAVILL 

The  primary  question,  of  course,  is:  Are  playgrounds 
susceptible  of  such  administration?  I  think  there  can  be 
no  contradiction  of  such  an  assumption.  To  that  end,  how- 
ever, two  great  principles  must  be  invariably  followed. 

The  playground  must  be  made  attractive  to  the  child 
and  wholesome,  and  so  unrestricted  as  to  give  to  every  child 
a  proprietary  interest.  On  the  other  hand,  by  every  con- 
ceivable means,  the  elders  must  be  brought  into  realization 
of  the  privilege  and  beneficence  of  the  playground,  and 
into  an  actual  cooperation  in  magnifying  the  interests  of 
children  as  a  principle  of  their  up-rearing.  To  bring  the 
unenlightened  or  even  the  so-called  enlightened  parent  to 
value  the  playground  as  he  values  the  schoolroom  is  a 
colossal  undertaking,  but  unless  this  can  be  accomplished 
the  work  will  fall  far  short  of  its  legitimate  possibilities. 

Is  it  not  obvious  that  what  you  do  with  your  playgrounds 
after  you  get  them  is  after  all  the  big  problem  in  its  sociologic 
or  civic  relationship?  Will  it  not  require  enlightenment, 
originality,  and  sympathy  on  the  part  of  the  governing 
body?  Is  it  not  in  danger  of  being  cramped,  stifled,  and 
dwarfed  by  the  application  of  that  popular,  fallacious,  and 
devitalizing  notion  of  ' '  business  administration ' '  ? 

Until  we  can  be  assured  that  business  management  shall 
be  employed  merely  as  a  matter  of  method,  and  that  the 
principle  and  spirit  underlying  playground  administration 
shall  be  intelligent  rather  than  commercial,  we  shall  never 
be  safe  in  handing  over  to  the  organization  bodies  the  man- 
agement of  this  great  community  interest. 

The  conclusion  which  I  wish  to  draw  is  plain  enough: 
the  organization  which  has  sufficient  interest  to  undertake 
to  procure  for  the  industrial  masses  this  vast  educational 
endowment,  must  maintain  for  its  successful  issue  a  strong, 
watchful,  and  imperative  supervision  which  shall  guarantee 
for  the  future  a  generous  reward  for  the  strenuous  and 
heroic  struggles  of  to-day. 


MJCDICINE     AND     1'  IJ  15  L  I  C     JI  i:  A  I.  T  Jl  237 

Dale  and  occnsidii  of  wriliiiK  unknown. 

SCHOOL   PLAYGROUNDS 

THE  question  of  the  relationship  of  physical  well-being 
to  the  body  politic  is  Vjccoming,  as  you  are  aware,  a 
very  burning  one.  Fragmentary  legislation,  sporadic 
cases  of  control,  efforts  to  bring  the  regulation  of  health 
conditions  under  the  general  influence  of  legislative  enact- 
ment, are  very  familiar  to  you.  It  is  true,  however,  that 
these  efforts  thus  far  are  unsystematic  and  continually  under 
the  jeopardy  of  judicial  discredit.  I  think,  however,  it  is 
safe  to  say  that  it  has  come  to  pass  that  the  vState  has 
awakened  to  its  own  consciousness  of  its  obligation,  not  to 
any  class  of  its  citizens,  but  to  itself,  and  upon  that  hypothe- 
sis the  State  has  undertaken  to  establish  its  right  to  dictate 
what  shall  be  the  conditions  of  health  under  the  general 
broad  provisions  of  police  power.  I  think  it  is  safe  to  say 
that  the  judicial  view  of  legislative  efforts,  in  the  direction 
of  controlling  conditions  of  living,  tends  fully  to  support  the 
contention  that  the  State  has  a  right,  with  reference  to 
preservation  of  its  own  integrity  and  welfare,  to  take  the 
broadest  cognizance  of  health  conditions  under  this  general 
idea  of  police  power. 

That  is  very  good  so  far  as  dealing  with  our  fixed  or 
current  conditions  is  concerned,  but  I  want  to  call  your  atten- 
tion to  the  fact  that  the  broadest  exercise  of  police  power, 
by  the  State,  after  all  deals  with  the  problem  in  masses, 
and  consequently  can  only  deal  w4th  phases  of  the  prob- 
lem and  influences  bearing  upon  the  problem  which  are 
simply  operative  under  mass  conditions.  Not  merely  that, 
but  hitherto  the  State,  in  dealing  mth  those  conditions,  for 
the  most  part  has  contemplated  and  dealt  with  terminal 
conditions, — conditions  in  which  damages  to  the  developed 
people,  as  distinguished  from  the  children,  have  already  been 


238  HENRY     BAIRD     FA  V  ILL 

brought  about,  and  the  consequent  good  which  can  be  ac- 
compHshed  by  State  control  of  all  classes  of  individuals  is 
comparativeh^  limited.  If  we  are  to  have  general  perfec- 
tion in  our  people  we  must  have  perfection  which  is  based 
upon  individual  quality,  individual  development.  How  this 
is  to  be  accomplished  is  the  greatest  problem  in  health 
matters  to-day.  The  personal  conditions  of  individuals  are 
largely  matters  of  habit.  The  most  personal  habits  of  indi- 
viduals with  respect  to  physical  matters  are  results,  partly 
of  education  and  partly  of  imitation.  Not  only  that,  but 
the  question  of  habit  is  perhaps  the  most  difficult  question 
from  a  therapeutic  standpoint  that  we  have  to  deal  with. 
There  is  hardly  anything  so  difficult  to  establish  in  our 
medical  relation  to  the  people  as  change  of  habit,  even  if 
beneficent,  obvious,  and  perhaps  of  the  slightest  degree. 
So  it  is  that  we  have  to  meet  and  control,  in  this  whole 
question  of  establishing  individual  perfection,  that  great 
inertia  represented  by  the  double  term  of  imitation  and 
habit. 

The  child  habit,  fortunately,  though  it  is  as  tenacious  in 
principle,  is  far  less  fixed  in  fact,  and  it  is  well  recognized 
by  all  educated  sociologists  and  by  all  physicians  that  the 
place  to  accomplish  radical,  fundamental,  and  progressive 
changes,  mental  or  moral,  is  in  childhood.  If  it  is  true  that 
childhood  offers  opportunity  to  influence  individual  develop- 
ment of  all  kinds,  we  must  come  to  the  conclusion  that  the 
place  where  it  is  most  worth  while  for  us  to  put  in  our  time 
and  effort  in  the  direction  of  physical  superiority  is  upon 
the  child. 

And  then  the  question  arises,  How  shall  we  do  it?  I 
may  be  mistaken  in  my  opinion  about  this,  but  my  opinion 
is  very  fixed:  No  great  progressive  movement  amongst 
children  or  adults,  and  particularly  amongst  children,  ever 
came  as  a  matter  of  compulsion  —  I  mean  primarily  and 
finally  compulsion.  Whatever  compulsory  factors  may 
enter  into  it  in  various  particulars,  compulsion  does  not 


MICDICINK      AND      I'  (J  H  L  I  C       H  lw\  L  I   U  239 

afford  a  reasonable  ] pathway  to  j^hysical  jjcrfection  of  the 
individual. 

What,  then,  is  there  left  for  us  to  consider?  So  far  as  I 
can  see — ^and  this  goes  right  along  from  babyhood  up  to 
and  through  adolescence  —  the  only  way  we  are  ever  going 
to  establish  a  broad  conception  of  physical  well-being  and 
physical  perfection,  a  conscious  desire  on  the  part  of  indi- 
viduals for  physical  perfection,  is  by  the  establishment  of 
some  kind  of  ideal  to  which  the  individual  shall  adhere, 
and  with  which  his  conduct  in  life  shall  in  some  degree  or 
other  square.  It  is  just  upon  that  point  I  start  my  argu- 
ment of  choice  for  a  playground.  How  are  we  going  to 
create  an  ideal  on  which  the  child  shall  build,  in  this  ques- 
tion of  physical  perfection  ? 

First,  let  me  ask,  what  do  we  understand  by  playground? 
Do  we  mean  simply  an  open  space  in  which  the  children  are 
to  romp?  Of  course,  better  than  nothing.  Any  form  of 
play  which  provokes  boisterousness,  or  anything  incident  to 
it,  is  far  better  than  inactivity  and  confinement  for  children. 
But  that  is  not  the  best  play.  What  we  mean  by  play- 
ground in  the  modern  sense  is  an  open  space,  equipped 
with  various  paraphernalia,  designed  to  be.  at  the  same  time, 
attractive  to  children  and  developmental  under  the  use  of 
the  children. 

We  are  not  talking  about  conditions  of  play  for  children 
in  the  country,  but  under  urban  conditions  where  there 
are  no  open  spaces,  no  resources,  nothing  except  what  the 
State  oflers  to  the  child  in  connection  with  public  parks  or 
the  public  schools.  Under  those  conditions  and  in  that 
line  what  we  mean  by  a  playground^  is  a  sort  of  outdoor 
gymnasium. 

Ho^w  are  we  going  to  utilize  such  an  outdoor  g^^mnasium 
for  the  purpose  of  creating  an  ideal  to  which  the  child's 
developmental  tendencies  shall  be  brought  into  harmony? 
That  is  a  matter  of  intelligence  and  ingenuity  on  the  part 
of  the  instructors  who  are  related  to  this  work,  and  if  you 


240  HENRY     BAIRD     FAVILL 

think  that  it  is  a  negligible  matter  you  are  vastly  mistaken. 
Whsit  can  be  accomplished  in  stimulating  children  to 
useful,  purposeful,  developmental  work  in  connection  with 
the  playground,  is  something  far  more  than  I  can  describe 
briefly.     It  is  of  the  utmost  importance,  however,  to  recog- 
nize that  children  have  their  mutual  ideas,  and  any  stu- 
dent of  psychology  will  say  that  the  process  which  aims  to 
develop  children  has  got  to  follow  the  course  of  child  psy- 
chology.    Consequently  it  requires  a  great  deal  of  study  to 
know  what  to  do  with  a  playground,  with  reference  to  the 
aggregate  mass  of  children.     Children,  of  course,  are  imi- 
tative, and,  to  a  large  extent,  the  good  or  bad  in  a  mass 
of  children  will  prevail   according    to  various    conditions, 
depending  on  their  imitative  tendencies, — but  more  than 
that,  children  are  emulative.     Children  will  tend  to  want  to 
excel,  provided  the  basis  of  excellence  that  can  be  estab- 
lished in  connection  with  pla^^grounds  is  an  obvious  basis. 
Let  me  illustrate  my  point  lest   I  may  seem  obscure. 
Dr.  Gulick  of  New  York  is  the  great  master  of  the  play- 
ground, and  in  developing  one  scheme  after  another  in  the 
evolution  of  the  work,  he  has  discovered  that  one  of  the 
most  potent  influences  he  can  bring  to  bear,  is  a  certain 
pride  that  children  can  be  made  to  have  in  definite  per- 
formance,  the  evidence  of  which  is  shown  in  wearing  a 
certain  kind  of  button  in  the  button-hole.     For  instance, 
"chinning  up"  on  a  horizontal  bar  so  many  times  is  accom- 
plished by  a  given  class  of  children,  and  this  is  rewarded 
by  a  definite  sign  button, — and  so  it  goes  on  from  phase 
to  phase  in    the   development   of   different   exercises,   the 
insignia  being  changed  as  the  development  goes  on,  to  the 
extent  of  absolutely  bringing  the  whole  body  of  children 
into  an  emulative  frame  of  mind.     Bear  in  mind,  there  is  a 
great  difference  between  the  emulative  and  contesting  frame 
of  mind. 

Not  only  are  these  influences  strong  in  their  tendency 
toward  physical  [development  and  superiority,  but  physical 


MEDICIN]-:      AND     JM    li  L  1  C     11  h  A  L  J  H  241 

vSuperiority  is  to  a  very  large  extent  exelusivc  of  mental  and 
moral  delinquency.  That  is  one  of  the  great  principles 
which  I  think  is  established.  The  tendency  of  good  health 
and  good  physique  is  to  exclude  degenerate  and  deteriorating 
influence  in  life,  and  so,  as  a  moral  effect,  as  a  prophylactic, 
as  a  character-breeding  or  citizen-breeding  influence,  I  have 
no  hesitation  in  saying  that  the  playground  could  be  made 
greater  than  the  school  curriculum,  and  I  have  consider- 
able hope  that  it  will  be  a  dominant  factor  before  the  school 
curriculum  shall  have  been  satisfactorily  adjusted. 

Of  all  our  problems  the  problem  of  great  importance  in 
the  way  of  dependency,  disease,  inefificiency,  whatever  you 
choose  to  call  it,  harks  back  in  the  last  analysis  to  physical 
vigor.  Laboring  men  have  come  to  realize  —  sociologists 
have  come  to  realize  —  that  the  great  industrial  problem 
to-day  is  health,  not  wages  or  shop  rules  or  unions,  but 
health.  That  being  the  case,  could  there  possibly  be  any 
greater  argument  for  the  development  and  universal  recog- 
nition of  the  dignity  of  the  playground  in  the  school  curri- 
culum? If  conditions  of  physical  perfection,  conditions  of 
physiologic  good  habits,  of  normal  and  sound  hygienic 
methods  of  living,  tend  to  exclude  in  the  child  vicious 
habits  of  growth,  mental  or  moral,  how  much  more  is  it  true 
as  applied  to  adolescent  and  adult  considerations? 

There  is  no  influence,  I  feel  convinced,  that  can  be 
more  successfully  brought  to  bear  upon  the  body  politic  in 
the  direction  of  sanity  and  morality  and  general  integrity, 
than  the  influence  which  can  be  developed  out  of  a  judicious 
and  intelligent  utilization  of  the  school  playground  principle. 


242  HENRY     BAIRD     FAVILL 


Delivered,  June  17,  1908. 

Printed,  Chicago  Medical  Recorder,  June  20,  1908. 

PRESIDENT'S   ADDRESS   TO   THE   CHICAGO 
MEDICAL   SOCIETY 

IN  presenting  a  brief  review  of  this  year's  history  of 
the  Chicago  Medical  Society,  I  wish  to  express  most 
earnestly  my  gratification  at  the  honor  which  was  con- 
ferred upon  me  in  electing  me  to  this  office,  and  my  grateful 
appreciation  of  the  marked  courtesy  and  cooperation  afforded 
me  in  all  directions  in  my  efforts  to  serve  the  Society. 

In  addition  to  the  sense  of  privilege  which  I  have  felt 
in  being  able  to  exert  some  effort  for  the  Society,  I  have 
experienced  an  added  pleasure  in  broadening  my  acquaint- 
ance with  the  members  of  the  Society  and  the  individual 
branches  which  compose  it.  No  one  can  undergo  this 
experience  without  being  conscious  of  having  grown  dis- 
tinctly in  knowledge  of  the  profound  importance  and  deep 
appreciation  of  its  labors. 

It  is  to  be  regretted  that  the.  great  size  of  the  Society 
prevents  such  wide  knowledge  on  the  part  of  every  indi- 
vidual. I  emphasized  the  fact  that  personal  intercourse 
throughout  the  membership  of  the  Society  is  not  only 
desirable  but  should  be  fostered  as  a  distinct  policy  of  the 
organization,  developed  on  the  broadest  lines  which  seem 
to  offer  real  results. 

The  work  of  the  Society  during  the  past  year  has  been 
uneventful,  generally  speaking,  but  when  viewed  critically 
in  respect  to  the  scientific  merit  of  the  work  both  in  the 
Branches  and  the  Central  meetings,  it  is  beyond  question 
that  the  grade  of  production  has  been  better  than  ever 
before. 

The  average  attendance  in  the  Branches  has  corre- 
sponded to  this  growth  in  scientific  work.  The  develop- 
ment of  the  Branches  is  not  yet  all  that  it  should  be.     The 


MEDICINE     AND     1'  U  li  L  1  C     HEALTH  243 

reflex  upon  the  professional  status  of  the  Branch  activities 
is  bound  to  be  j^rogressively  greater,  and  yet  it  must  be 
borne  in  mind  that  the  fullest  development  in  the  way  of 
stimulus  to  professional  excellence  involves  a  conscious  and 
real  relationship  to  the  main  society  and  through  that  to 
the  organized  medical  fraternity  of  the  country. 

The  meetings  of  the  Central  Society  this  year  have  been 
extremely  gratifying.  There  have  been  many  programs  of 
a  very  high  degree  of  excellence  and  the  attendance  has  not 
only  averaged  larger,  but  has  obviously  been  tending  to 
increase  steadily.  Part  of  this  is  due  to  having  the  meet- 
ings in  a  far  more  suitable  place,  but  in  the  end,  the  excel- 
lence of  the  program  will  be  the  determining  fact. 

It  seems  to  me  desirable  under  the  conditions  in  which 
we  work  that  the  hour  of  meeting  should  be  at  half-past 
eight  instead  of  eight  o'clock.  It  is  very  desirable  that  the 
men  from  the  outskirts  should  be  able  to  participate.  Most 
of  them  have  work  in  the  evening.  The  distances  are  very 
great,  and  as  a  practical  point,  in  my  judgment  after  care- 
ful observation,  I  believe  the  hour  of  eight-thirty  will  give 
better  results.  This  will  permit  meetings  to  be  called 
promptly  on  time,  which  this  year  I  have  not  seen  fit  to  do. 

The  meetings  with  the  affiliated  societies  have  been 
thoroughly  profitable.  It  is  noticeable  that  more  people 
are  doing  scientific  work  of  a  grade  which  deserves  dis- 
tinguished notice.  Keeping  pace  with  the  strong  advance 
in  educational  circles,  particularly  in  the  line  of  research, 
the  rank  and  file  of  the  profession  is  finding  it  worth  its 
while  to  participate  in  laborious  stud}^  and  present  its  results. 
Naturally  the  special  societies  will  push  on  strongly  in  this 
matter  and  there  ought  to  be  a  great  volume  of  valuable 
work  presented  in  the  future. 

This  year  has  seen  instituted,  and  demonstrated  as 
practicable,  the  Business  Bureau.  Thanks  to  the  persistent 
and  confident  eft'ort  of  the  Committee  on  Business  Bureau, 
what  used  to  seem  to  many  of  us  an  impractical  scheme 


244  HENRY     B  A  I  R  D     F  A  V  I  L  L 

has  been  brought  to  a  successfiil  working  basis.  So  far  as 
one  can  judge,  the  future  of  that  enterprise  is  assured,  and 
if  so  its  value  to  the  profession,  as  an  element  of  strength, 
harmony,  and  prosperity,  is  beyond  estimate. 

It  seems  to  me  very  important  that  the  functions  of  the 
Business  Bureau  should  not  be  increased  until  it  has  thor- 
oughly mastered  its  present  activities.  There  is  no  doubt 
that  the  future  will  open  many  possibilities,  but  I  can  not 
too  strongly  urge  the  perfecting  of  present  plans  before 
branching  out. 

The  activities  of  the  Council  have  been  important  during 
the  year.  Whereas  some  of  the  Committee  have  completed 
their  labors  for  the  time  being,  and  are  at  the  moment  inac- 
tive, others  have  taken  up  work  strongly  and  constructively 
which  should  be  continued  without  relaxation.  The  basis 
of  all  achievement  in  professional  as  well  as  social  develop- 
ment, is  continuity,  and  nothing  is  so  wasteful  as  even 
temporary  relaxation. 

The  Committees  dealing  with  hospital  abuse,  dispensary 
abuse,  contract  practice,  and  relations  to  medical  education, 
should  be  continued  and  their  work  earnestly  supported. 

The  medical  profession  has  never  had  the  weight  in  pub- 
lic affairs  to  which  it  is  entitled.  The  general  unitedness 
of  the  profession,  however,  gives  promise  that  in  the  future 
its  influence  will  be  recognized.  With  reference  to  that 
end  our  strong  organization  is,  of  course,  fundamental.  In 
order,  however,  to  become  effective,  the  subjects  with  which 
it  ought  to  deal,  and  upon  which  its  forces  should  concen- 
trate, must  be  focused  by  some  stable  machinery,  and  to 
this  end  I  believe  and  recommend  that  the  Committee  on 
Public  Relations  should  be  continued  strong,  and  should  be 
encouraged  by  enthusiastic  cooperation  to  take  up  public 
questions,  outline  their  scope,  and  organize  the  professional 
sentiment  and  effort  toward  their  solution.  I  strongly  urge 
the  necessity  of  a  body  which  shall  initiate  action  in  order 
to  secure  full  benefit  of  our  organic  power. 


M  E  D  i  r  I  N  10      AND      I'  I     15  I,  I  (        III.  Af-'[ll  245 

A  distinct  advance  with  rcsj)cct  to  the  or^ani/.ation  of 
the  Council  has  been  made  in  the  Constitutional  Amend- 
ment looking  to  an  equitable  reapjjortionment  of  repre- 
sentation from  the  Branches.  So  far,  it  appears,  this 
subject  has  been  satisfactorily  adjusted.  There  are  many 
flaws  and  discrepancies  in  the  constitution  and  by-laws. 
It  is  very  imperative  that  these  be  taken  up  systematically, 
and  the  whole  matter  harmf)nized  and  put  into  definite 
form. 

The  Committee  appointed  by  the  Council  to  take  up  this 
question  was  appointed  too  late  for  effective  work  this  year. 
That  Committee  dies  with  the  expiration  of  this  year  and 
should  be  reappointed  with  instructions  to  do  as  much  work 
as  is  practicable  during  the  summer. 

The  last  few  weeks  have  seen  the  development  of  a  very 
stirring  political  campaign  with  reference  to  the  offices  of 
this  Society.  Generally  speaking,  I  can  conceive  of  no 
more  healthy  fact  than  universal  interest  in  our  election. 
It  is  probably  inevitable,  and  there  is  no  objection  to 
strong  factional  activity  with  reference  to  elections.  There 
are  two  considerations,  however,  which  the  members  of 
the  Chicago  Medical  Society  must  honestly  and  disinterest- 
edly weigh  in  connection  with  such  political  activity : 

1.  The  issues  must  be  issues  of  principle  and  policy 
and  not  issues  of  selfishness. 

2.  In  the  pursuit  of  political  supremacy  in  the  Society 
based  upon  issues  of  principle  and  policy,  personal  interests 
and  private  antagonisms  must  be  eliminated. 

Recognizing  the  tendency  in  human  affairs  to  acrimony 
in  the  heat  of  strife,  I  yet  enunciate  as  a  fact,  demonstrated 
times  without  number,  that  in  the  long  run  selfishness  and 
personal  interest  will  be  recognized  by  the  rank  and  file  and 
effectually  and  permanently  discredited. 

The  work  of  the  Chicago  Medical  Society  has  onl}-  just 
begun.  Its  influence  as  a  force  in  this  community  is  not 
one  tithe  of  its  due.     Its  power  for  achievement  must  not 


246  HENRY     BAIRD     FA  V  ILL 

be  permitted  to  be  dissipated  by  the  development  of  dissen- 
sion growing  out  of  a  struggle  for  office.  The  man  who 
sacrifices  the  real  interests  of  the  Society  to  his  personal 
ends  is  a  traitor,  and  the  Societ}^  must  be  kept  awake  to  its 
true  dignity  and  be  so  intelligent  that  no  abnormal  or 
illegitimate  exploitation  can  long  prevail. 

At  this  writing  I  have  no  idea  as  to  the  outcome  of  this 
election.  Whatever  that  outcome  may  be,  I  urge  upon  the 
Society  the  instant  burying  of  animosity  and  the  full  deter- 
mination in  the  interests  of  the  Society  and  in  the  interests 
of  that  public  usefulness  which  is  in  our  charge,  that  we 
steadily  and  honestly  pull  together. 

It  is  my  deliberate  judgment  that  in  the  interests  of  the 
Society  there  should  be  some  definite  way  by  which  the 
retiring  president  should  be  continued  automatically  for 
a  time  in  intimate  relation  to  the  conduct  of  the  affairs  of 
the  Society.  No  matter  how  diligent  his  study,  or  how 
untiring  his  effort,  no  president  can  do  more  in  one  year 
than  acquire  a  full  understanding  of  the  issues  involved  as 
between  the  profession  and  the  public  and  the  possibilities 
of  action  on  the  part  of  the  Society.  By  the  time  his 
mental  operation  is  mature  his  term  as  president  termi- 
nates, and  unless  he  happens  to  get  a  seat  in  the  Council 
by  election,  his  greatest  usefulness  to  the  Society  is  over. 

I  recommend,  therefore,  in  the  readjustment  of  the  Con- 
stitution, that  a  provision  be  made  for  the  continuance  of 
the  retiring  president  for  a  reasonable  length  of  time  in  the 
Council  of  the  Society. 

That  this  recommendation  is  in  the  interests  of  the 
Society  and  not  at  all  in  the  interests  of  the  individual  must 
be  perfectly  obvious.  In  fact,  at  the  end  of  an  industrial 
term,  as  a  rule,  the  president  would  prefer  to  be  relieved 
from  duties,  but  the  Society  can  not  afford  to  dispense  with 
the  intelligence  of  men  whom  it  has  seen  fit  to  elect  to  office 
and  whose  opportunities  for  comprehensive  judgment  are 
thereby  greatly  enhanced. 


M  l<:  I)  I  (■  [  NIO      A  N  F)       I'll',  l,l(       III.  A  1,1   II  247 

The  fact  thai  this  rccommcnflation  is  purely  for  the 
Society's  benefit  and  absolutely  unrelated  to  the  indi- 
vidual's benefit,  is  my  justi/lcatiou  for  making  a  recom- 
mendation in  its  nature  somewhat  delicate. 

In  closing  I  wish  to  reiterate  my  conviction  that  the 
Chicago  Medical  Society  has  not  crossed  the  threshold  of 
its  usefulness  or  greatness,  and  that  all  that  is  necessary  to 
the  consummation  of  its  highest  promise  is  clear  judgment 
and  unselfish  devotion. 


248  HENRY     BAIRD     FAVILL 


Delivered,  International  Tuberculosis  Congress,  Washington,  D.  C,  Sep- 
tember 29,  1908. 

Printed,  Thirteenth  Biennial  Report  of  the  Bureau  of  Labor  and  Industrial 
Statistics,  State  of  Wisconsin,  1907-8. 

LEGITIMATE   EXERCISE   OF   POLICE   POWER 
FOR   THE   PROTECTION   OF   HEALTH 

THE  difficulty  of  police  regulation. — There  is  a  difficulty 
which  must  not  be  overlooked  or  underestimated  in 
an  effort  to  exercise  legal  mandates  and  restraints  as 
between  employers  and  the  employed.  This  difficulty  is 
the  antagonism  which  has  developed  out  of  superficial  and 
apparent  conflict  of  interest,  an  antagonism  which  permeates 
the  entire  social  fabric.  While  social  philosophy  could  dem- 
onstrate the  identity  of  interest  in  almost  every  instance, 
it  is  unreasonable  to  expect  that  the  ideal  conception  of  the 
social  philosopher  will  prevail  upon  both  sides  of  this  con- 
troversy as  an  initial  step.  Experience  teaches  that  con- 
tention and  compromise  are  the  steps  by  which  progress  is 
made.  While  it  is  not  beyond  hope  that  an  understanding 
and  fair  agreement  will  ultimately  reduce  differences  to  the 
minimum,  there  are  many  objections  to  the  exercise  of 
unlimited  patience  during  the  working  out  of  the  problem 
of  industrial  sanitation.  To  any  extent  that  portions  of  the 
subjects  in  question  can  be  made  to  appear  more  important 
and  more  obvious  than  others,  an  attempt  should  be  made 
to  deal  with  them  as  individual  factors,  separating  them  if 
possible  from  the  general  mass  of  industrial  questions,  and 
particularly  striving  to  escape  the  hindrance  from  both  sides 
which  naturally  attaches  to  industrial  disputes. 

True  basis  of  police  regulation.  —  If  it  can  be  made  to 
appear  that  society  as  a  whole  demands  for  its  own  preserva- 
tion the  carrying  out  of  a  definite  policy,  its  mandate  upon 
both  capital  and  labor  can  be  supreme,  residing  far  above 
the  level  of  factional  or  class  controversy.     It  is  upon  this 


MEI)I(    INIC     AND     1'  U  Ji  L  I  C     H  J-:  A  L  T  H  249 

ground  that  the  interpretation  of  "  I'oliee  I^ower"  must 
operate. 

In  the  industrial  world,  health  is  the  foundation  of  pro- 
ductiveness and  the  bulwark  of  economy.  That  society 
and  progress  dei)end  utterly  upon  these  factors  can  hardly 
be  questioned.  It  is  hence  only  necessary  to  reach  a  con- 
clusion as  to  the  fundamental  importance  of  health  as 
related  to  the  product  of  any  individual,  or  to  have  a  com- 
prehensive grasp  of  the  elements  of  waste  and  dissipation 
in  social  afTairs,  to  at  once  put  the  question  of  public  health 
as  a  thing  apart  to  be  dealt  with  as  a  social  problem  irre- 
spective of  its  particular  bearing  upon  any  class  of  citizens. 
From  this  point  of  view,  what  Labor  demands  will  be  quite 
as  irrelevant  as  what  Capital  refuses.  The  question  will  be 
more  simple  and  more  difficult. 

What  is  the  sound  position  to  take  with  regard  to  public 
health  necessities  ?  What  is  the  wise  course  to  pursue  in  the 
development  of  operating  plans? 

Police  power  as  an  aid  to  research.  — It  must  be  apparent 
that  the  question  of  sound  doctrine  as  to  sanitary  facts  is 
not  only  preliminary  but  fundamental  to  any  broad  and 
radical  exercise  of  police  power.  It  is,  how^ever,  obvious 
that,  pending  the  development  of  substantial  knowledge, 
extensive  regulation  must  proceed,  more  or  less  temporary 
in  its  character,  and  it  is  also  manifest  to  those  who  are 
studying  the  problem,  that  large  police  cooperation  is 
essential  in  the  establishment  of  the  facts  underlying  pub- 
lic disability.  It  is  important,  therefore,  to  recognize  that 
the  immediate  structure  will  be  temporary,  and  that  much 
of  the  police  power  that  it  is  necessary  to  invoke  will  be  for 
purposes  of  research  rather  than  finally  satisfactory-  for 
purposes   of  sanitation. 

Our  courts  and  the  police  power.  —  In  common  with  other 
statutory  functions  in  its  jurisprudence,  police  power  in 
the  United  States,  has  aspects  w^hich  are  not  prominent  in 
the  legal  administration  of  European  government.     In  the 


250  HENRY     BAIRD     FA  V  ILL 

United  States,  legislative  enactment  is  not  paramount  but 
is  subject  to  construction  and  destruction  through  judicial 
review.  This  is  a  feature  of  national  policy,  fundamental 
and,  so  far  as  we  know,  permanent.  There  is  no  doubt  that 
it  exerts  a  distinct  retardation  upon  what  might  be  regarded 
as  progressive  legislation.  It  is  not  likely,  however,  that 
legislation,  which  is  directed , primarily  to  the  preservation 
of  health,  is  going  to  be  seriously  hampered  by  our  consti- 
tutional limitations  upon  arbitrary  legislation. 

The  trend  of  judicial  statement  is  on  the  whole  clear. 
The  broad  interests  of  society  upon  the  side  of  health,  if 
they  can  be  defined,  seem  to  be  of  paramount  importance  in 
judicial  opinion.  It  is  well  to  observe,  however,  that  the 
courts  will  not  sustain  legislation  for  the  correction  of  even 
admitted  abuse  which  can  be  interpreted  as  distinctly  class 
legislation.  For  example,  the  bakers  of  New  York  failed 
upon  this  ground  to  secure  the  relief  obviously  important. 
On  the  other  hand,  the  interests  of  the  body  politic  repre- 
sented in  the  physical  well-being  of  women,  was  recognized 
as  imperative  in  the  decision  affecting  the  recent  Oregon 
cases.  For  our  purpose,  as  advocates  of  legislative  assist- 
ance in  sanitary  reform,  this  distinction  is  of  the  utmost 
importance. 

The  need  of  accurate  knowledge. — The  interest  that  the 
State  can  show  in  sanitation  will  carry  greater  weight  than 
any  degree  of  interest  of  immediate  beneficiaries.  It  is 
noteworthy,  moreover,  that  the  courts  are  susceptible  to 
demonstration  as  to  the  essential  facts.  Ex  cathedra  state- 
ment receives  and  deserves  scant  consideration.  Pains- 
taking accumulation  of  relevant  data  carries  the  utmost 
weight.  The  hand-maiden  of  public  interest,  therefore,  is 
breadth  and  accuracy  of  statement.  With  these  grounds 
properly  covered,  the  prospect  is  that  legislation  can  proceed 
fully  as  rapidly  as  the  necessary  basis  in  fact  can  be  estab- 
lished. 

The  health  of  the  people  stands  as  a  subject  of  admin- 


MEDICINI':     AND     J'  U  JJ  L  I  C     ill.  Al.  JJl         251 

istrativc  scrutiny  without  question.  In  view  of  that  fact, 
and  the  further  faet  that  pohee  power  in  Ameriean  law  is 
so  reeent  as  to  have  no  deeply  rooted  traditions,  it  seems 
probable  that  the  future  of  this  question  will  rest  to  a  large 
extent  upon  those  branches  of  the  medical  profession  which 
are  active  in  sanitary  research.  Cooperation  between  the 
physicians  and  sociologists,  with  the  development  of  a  zone 
between  them  which  shall  have  the  characteristics  of  both, 
seems  to  be  the  method  of  attack. 

At  this  point  we  may  well  ask,  Upon  the  basis  of  our 
present  knowledge,  what  are  we  justified  in  pointing  out 
as  public  necessities  ? 

The  tuberculosis  problem. — Tuberculosis  presents  on  the 
whole  the  most  complex  and  most  important  example  of 
social  evil.  No  other  disease  has  the  same  economic  import- 
ance; no  other  is  so  interwoven  with  industrial  conditions; 
no  other  has  such  relation  to  habitation.  The  fact  that 
measures  of  correction  in  one  direction  do  not  reach  a  full 
result,  while  evils  continue  uncorrected  in  other  directions, 
is  not  ground  for  hesitation  in  urging  legislation.  Experi- 
ence shows  that  reform  breeds  reform,  and  that  a  wise 
standard  is  effective  in  its  influence  upon  correlated 
matters. 

The  difficulty  of  habitation  reform.  —  It  is  but  necessars^ 
to  realize  how  complex  the  habitation  question  is,  to  recog- 
nize the  difficulty  of  starting  from  that  side.  Ideal  habi- 
tation associated  with  bad  habits  would  have  slight  results. 
The  task  of  re-education  of  the  masses  in  their  hygiene  is 
colossal  and  will  take  more  systematic  effort  and  far  greater 
time  than  all  the  other  phases  of  tuberculosis  warfare. 

Industrial  life  the  true  point  of  attack. — While  it  is  per- 
fectly obvious  that,  so  long  as  there  is  lack  of  good  hab- 
itation conditions  and  reasonable  hygiene,  the  benefit  of 
improvement  in  the  conditions  of  industry  vdW  be  to  some 
extent  neutralized,  it  is  nevertheless  true  that  industrial 
life  is   the  point   of  advantage   from   which   to  undertake 


252  HENRY     BAIRDFAVILL 

reorganization.  Not  only  is  it  possible  to  establish  phys- 
ical conditions  in  which  the  workers  will  be  comparatively 
safe,  but  it.  is  inevitable  that  the  reflex  upon  their  personal 
views,  tastes,  and  habits  will  profoundly  affect  their  habita- 
tion vices. 

The  argument  that  has  been  and  will  continue  to  be 
urged  against  the  regulation  of  working  conditions,  that 
such  legislation  is  futile  in  view  of  the  home  conditions, 
appears  to  me  to  have  no  considerable  weight.  I  believe 
that  close  scrutiny  and  regulation  of  working  conditions 
anywhere  and  to  any  extent,  that  can  be  made  to  square 
with  a  rational  statement  of  economic  necessity,  is  right  to 
demand  and  reasonable  to  expect. 

It  is  for  this  reason  that  educational  propaganda  should 
be  universal.  While  it  is  true  that  the  masses  are  the 
great  sufferers  from  tuberculosis,  and  need  the  utmost  in- 
dustry for  their  education,  it  is  also  true  that  the  forces 
which  influence  legislation  at  present  arise  in  quarters  where 
the  consciousness  of  the  need  is  far  less  personal  and  con- 
sequently slow  to  develop. 

Employers  must  cooperate. — The  task  of  securing  legis- 
lation affecting  working  conditions  in  our  present  system 
of  industry  can  hardly  be  accomplished  without  coopera- 
tion of  employers.  Whether  or  not  in  the  end  that  could 
be  done,  wisdom  requires  that  cooperation  be  assiduously 
sought. 

The  economic  soundness  of  the  warfare  against  tuber- 
culosis ultimately  will  prevail,  and  the  more  teachers  of 
economics  concentrate  upon  this  demonstration,  and  the 
more  powerful  commercial  forces  are  enlisted  in  this  effort, 
the  speedier  will  be  the  result. 

Voluntary  effort  inadequate.  —  It  is  not  likely  that  mere- 
ly voluntary,  or  even  cooperative,  regulation  is  the  best 
solution.  Rules  applied  to  an  industrial  establishment, 
which  are  not  purely  related  to  the  immediate  product  of 
industry,  are  difficult  of  enforcement  and  liable  to  contro- 


MEDICI  N[<:      AND      IM     I',  J,  I  (        III;  A  LIU  253 

versy.  There  is  no  ])rospecl  of  such  general  development 
of  intelHgence  and  cooperative  spirit  amongst  employers  as 
will  ensure  sufficient  uniformity  of  process.  There  is  no  way 
to  insure  the  acceptance,  on  the  part  of  laborers,  of  con- 
ditions which  may  be  to  them  distasteful,  except  through 
authority  backed  up  by  universal  custom.  There  is  no 
reasonable  doubt  that  it  is  in  the  interest  of  employers, 
not  only  from  an  economic  standpoint,  but  in  respect  to 
the  practicability  of  instituting  reform,  that  these  measures 
be  mandatory  and  the  expression  of  a  very  radical  State 
policy. 

Endeavor  to  prevent  contagion  inadequate. — The  ordinary 
regulation  of  an  establishment  from  the  standpoint  of 
contagion  is  comparatively  easy  to  effect.  Once  the  facts 
can  be  established,  and  a  practicable  method  of  meeting 
the  requirements  determined,  it  is  quite  within  the  powers 
of  existing  authorities  to  carry  into  effective  operation 
the  necessary  measures. 

Although  this  will  meet  a  demand  made  by  the  charac- 
teristics of  tuberculosis  as  an  infectious  disease,  it  will 
after  all  encompass  a  very  small  part  of  the  good  that  can 
be  done  in  the  workshop.  Infection  resulting  from  con- 
tagion is  a  very  late  step  in  the  tuberculosis  cycle.  There 
will  probably  always  be  enough  tubercular  matter  in  exist- 
ence to  infect  all  the  people  who  can  be  found  susceptible 
to  it. 

Vigor  more  than  protection. — Though  not  at  all  under- 
rating the  importance  of  diminishing  the  opportunities  for 
contagion,  while  the  vast  majority  of  people  are  still  in  a 
state  unduly  susceptible  to  the  infection,  it  must  be  recog- 
nized that  the  foundation  of  immunity  is  not  protection 
but  vigor. 

The  idea  is  far  too  prevalent  that  the  fresh  air  element 
in  the  tuberculosis  question  is  related  to  the  purifying  value 
solely.  Granting  that  at  any  value  you  may,  it  is  still  true 
that  the  value  of  fresh  air  is  as  a  physiologic  stimulus  to 


254  HENRY     BAIRD     FAVILL 

the  individual,  and  that  it  is  inexpressibly  more  potent  for 
that  reason  than  for  all  others.  This  does  not  gainsay  the 
enorrhous  danger  of  concentrated  polluted  air,  but  again 
and  again  it  is  necessary  to  emphasize  the  physiologic  aspect 
of  immunity  as  against  the  fortuitous  escape  from  contact. 

Air  hunger  must  be  developed. — With  this  in  mind,  one 
reaches  a  conclusion  as  to  what  must  be  done  for  the  race. 
Conditions  of  social  existence,  perhaps  fairly  to  be  called 
civilized,  have  a  strong  bearing  toward  enfeeblement.  With 
possibilities  for  comfort  come  self-indulgence,  to  the  extent 
of  modifying  normal  tastes  and  stifling  activities  upon 
which  bodily  vigor  depends.  This  is  true  upon  all  levels  of 
society.  The  reawakening  of  air  hunger,  the  establishment 
of  standards  of  air  distribution,  and  the  creation  of  a  morale 
with  reference  to  air  privilege,  are  radical  and  imperative 
necessities  before  substantial  progress  can  be  made. 

The  workshop  as  a  point  of  departure.  — At  no  point  in  the 
experience  of  any  worker  can  these  things  be  more  advanta- 
geously achieved  than  in  his  workshop.  For  him  who  has 
no  initiative  and  scant  opportunity,  it  is  the  duty  of  the 
State  to  declare  that  conditions  reasonably  calculated  to 
secure  these  benefits  shall  be  the  standard  conditions  of 
labor.  Upon  that  basis  as  a  primary  demand,  the  State 
can  and  should  exercise  its  police  power  and  establish 
standards  of  air  exposure  sufficient  to  accomplish  these 
results. 

Opposition  of  employers  and  employees. — It  is  by  no 
means  a  simple  proposition.  The  most  superficial  considera- 
tion of  what  it  involves  shows  a  prospect  of  opposition  on 
the  part  of  both  employers  and  employees.  From  the  stand- 
point of  expense,  the  aggregate  demand  would  be  heavy,  but 
opposition  on  this  score  will  subside  when  once  the  enor- 
mous increase  in  labor  efficiency  is  demonstrated.  The 
difficulty  of  determining  the  proper  type  of  air  exposure  for 
different  industries  would  be  very  great.  The  world-wide 
prejudice  against  low  temperatures  and  free  circulation  of 


M  I-;  I)  I  C  I  N  [C      AND      IMJI5LIC;      IIICAI^TH  2%^ 

air  is  dc('])ly  rooted.  One  can  hardly  conceive  an  innova- 
tion fratij^lit  with  more  difficulties  to  accomplish.  It  is, 
however,  fundamental,  and  1)y  no  possibility,  so  far  as  we 
now  see,  can  ^rcat  results  be  otherwise  achieved.  If  the 
proposition  is  sound,  it  may  well  answer  the  first  question 
which  I  have  propounded  as  to  what  position  to  take  in 
this  matter. 

Need  of  fundamental  action. — We  are  not  here  to  look 
for  superficial  or  temporizing  measures.  If  there  is  a  rad- 
ical standpoint  with  respect  to  which  we  can  confidently 
speak,  we  must  occupy  it.  Not  only  are  all  other  sanitary 
adjustments  more  or  less  ancillary,  but  this  in  itself  con- 
stitutes a  basis  for  agitation  large  enough  to  occupy  the 
entire  attention  of  sanitary  and  sociologic  effort  in  the 
direction  of  protection  of  the  health  of  laborers. 

The  second  question  is.  What  is  the  wise  course  to  pur- 
sue in  the  development  of  operating  plans  ? 

We  must  study  the  relation  of  health  to  labor.  —  It  needs 
no  argument  to  maintain,  that  abundant  data  and  well 
considered  demonstration  will  be  necessary  to  bring  to  pass 
this  great  reform.  It  is  not  the  purpose  of  this  discussion 
to  go  into  the  detail  of  the  research  leading  to  this  end. 
It  is  agreed  that  labor  legislation  must  have  its  foundation 
in  clear  economic  advantage.  It  is  perhaps  not  so  well 
agreed,  but  the  idea  is  rapidly  growing,  that  of  all  the  factors 
of  an  economic  advantage,  health  is  the  most  crucial.  Up- 
on this  hypothesis,  therefore,  the  conclusion  may  rest,  that 
the  logical  primary  step  is  the  establishment  of  broad  and 
effective  study  of  health  as  related  to  laboring  conditions. 

While  we  must  advocate  and  work  for  temporar}-  and 
halfway  measures  of  relief,  in  the  interest  of  those  now  en- 
dangered by  unsanitary  conditions,  we  must  hold  in  view 
constantly  a  deeper  and  more  important  purpose,  the 
establishment  of  an  entirely  new  conception  of  what  are 
sanitarv^  conditions. 

The    problem    of   offsetting    the   detrimental    influence    of 


256  HENRY     BAIRD     FAVILL 

urban  life.  —  To  what  extent  aggregated  masses  can  be 
made  to  accommodate  themselves  to  artificial  ways  of  life, 
is  of  course  a  question,  but  there  is  no  reason  to  suppose 
that  this  can  take  place  to  any  great  extent,  and  we  have 
absolutely  no  warrant  in  acting  at  all  upon  such  an  assump- 
tion. The  world  has  got  to  reach  a  decision  as  to  how  to 
offset  the  detrimental  influence  of  urban  life.  At  no  point 
in  the  entire  discussion  will  there  be  opportunity  for  more 
valuable  contribution  to  the  solution  of  that  question  than 
at  this:  the  fight  for  fresh  air  during  working  hours  as  a  pre- 
ventive of  tuberculosis. 

I  believe  firmly  that  the  State  may  legitimately  exercise 
its  police  authority  over  this  question.  I  believe  as  firmly 
that  it  can  never  be  accomplished  otherwise,  and  I  believe 
finally  that  there  is  no  greater  obligation  resting  upon 
sanitarians  than  to  prove  conclusively  the  necessity  and 
point  out  clearly  the  way. 


MEDIC  I  NIC      AND      IMIULir      II  i:  A  I.  T  H  257 


Delivered,     FifUi     Aniiu.-il     (''inference     on     CIiiM      Labor,     (^hieaj^o, 

January    21-23,    1909. 
Under  Auspices  of  the  National  Child  Labor  Committee. 
Printed,  Supplement  to  Annals  of  the  American  Academy  of  Polilical 

and  Social  Science,  March,  1909. 

THE   FEDERAL   CHILDREN'S    BUREAU 

IT  would  be  a  very  false  conception  of  the  problem 
which  we  have  met  to  discuss,  if  it  were  assumed  that 
in  purpose  the  forces  which  we  try  to  overcome  are 
directly  antagonistic.  I  think  it  is  safe  to  say,  that  with 
very  rare  exception  there  is  not  an  employer  of  children  in 
mine,  factory,  or  sweatshop  who  would  not  prefer  a  different 
and  better  order  of  things. 

Conditions  of  industrial  life  develop  slowly  and  com- 
pactly, and  it  is  as  a  final  and  at  the  moment  inevitable 
phase  that  child  labor  bursts  into  its  full  enormity.  So  the 
employers  of  children  find  themselves  confronted  by  a  con- 
dition quite  irrespective  of  individual  preference;  a  condi- 
tion so  related  on  the  one  hand  to  industrial  competition 
and  cost  of  production,  and  on  the  other  to  labor  compe- 
tition and  the  struggle  for  existence,  that  they  move  on 
with  a  fatalistic  insensitiveness  that  puts  them  in  the  minds 
of  many  into  a  class  of  malefactors  to  whom  are  too  readily 
ascribed  the  responsibility  for  the  outrages  which  they  more 
or  less  perpetrate.  That  they  are  terribly  culpable  is  true 
in  spite  of  extenuating  circumstances,  but  that  they  are 
voluntarily  initiating  the  system  which  we  deplore  is  not 
at  all  true.  What  they  do,  they  do  because  they  rest  upon 
that  ancient  fallacy  that  business  necessity  is  paramount 
to  other  social  considerations. 

They  are  not  alone  in  this  misconception.  Thousands 
of  right-minded,  fairly  intelligent  men  and  women  partic- 
ipate in  the  expression  which  has  hardly  the  dignity  of  an 
opinion,  that  radical  disturbance  of  the  social  order  is  bad. 
I  speak  slightingly  as  to  so-called  opinions  on  these  matters 

10 


2S8  HENRY     BAIRD     FAVILL 

because  it  is  eternally  true  that  no  opinion  is  worthy  the 
name  which  has  not  as  its  foundation  a  reasonable  under- 
standing of  the  facts,  and  I  assert  without  hesitation  that 
the  majority  of  those  highly  respectable  conservatives, 
who  are  satisfied  to  let  things  work  out  their  own  solution, 
are  profoundly  ignorant  of  the  conditions  which  they  con- 
done. To  the  masses  of  citizens  who  are  indisposed  to  move 
in  these  measures  of  reform  are  to  be  added  still  other  masses, 
who,  because  of  their  notions  of  political  economy,  object 
to  legislative  regulation  or  to  administrative  control  through 
governmental  bureaus. 

Without  approaching  the  abstract  argument  upon  this 
subject,  those  who  have  made  this  matter  a  deep  and 
conscientious  study,  reach  conclusions  applying  to  the  con- 
crete facts,  with  great  definiteness.  Absolute  control  of 
the  health  of  the  individual  can  never  be  the  function  of 
the  State.  Control  of  the  conditions  under  which  the  lives 
of  the  people  shall  be  lived  and  their  energies  expended,  is 
an  inevitable  necessity.  The  State  will  approach  this  prob- 
lem from  the  standpoint  of  self-preservation.  Defective 
health  is  the  foundation  of  crime,  pauperism,  and  degen- 
eracy, as  well  as  that  widespread  inefficiency  due  to  obvious 
disease. 

All  sociologic  forces  have  come  to  recognize  this  fact. 
The  physical  well-being  of  the  people  is  the  deepest  interest 
of  the  State.  If  the  State  is  to  undertake  the  establish- 
ment of  conditions  designed  to  safeguard  health,  it  is  im- 
perative that  the  foundation  of  accurate  knowledge,  upon 
which  to  base  radical  and  comprehensive  legislation,  be 
laid.  The  detail  of  such  legislation  is  too  remote  to  engage 
our  attention  here.  What  we  must  strive  for  is  knowledge, 
and  to  this  end,  the  interested  forces  demand  a  National 
Bureau  of  Health,  the  most  valuable  function  of  which 
shall  be  the   culture  of   intelligence  upon  these  subjects. 

If  this  proposal  shall  become  effective,  it  will  appear  to 
many  that  the  end  which  we  seek  has  been  accomplished. 


M  ]<:  I)  I  (    I  N  I';      AND      I'll',  l.l(        JiJ'.  y\l.lll  259 

That  will  not  be  true  unless  the  interests  which  we  represent 
be  specifically  defined.  The  medical  profession  has  only 
within  a  few  years  come  to  realize  that  child  health  and 
adult  health  present  distinctly  difl^erent  problems.  Our 
literature  upon  the  ])hysical  as])ects  of  childhood  is  very 
recent  and  meager.  Our  scientists  who  have  devoted 
themselves  to  child  welfare  are  comparatively  few;  yet  one 
glance  at  the  broad  proposition  should  be  convincing.  Con- 
sider the  difference  in  the  questions  involved  as  to  how  an 
individual  goes  out  of  the  world  and  how  that  individual 
comes  into  the  world.  Is  it  not  obvious  that  with  reference 
to  determining  the  type  of  an  individual,  and  hence  his 
value  to  society,  the  first  few  years  are  inexpressibly  more 
important  than  all  the  rest?  Let  us  go  even  further  than 
that,  and  say  that  questions  involved  in  the  period  before 
birth  or  conception,  which  are  coming  to  be  recognized  as 
profound  and  crucial,  are  only  to  be  interpreted  in  the 
light  of  the  deepest  knowledge  of  child  life. 

That  there  must  be  in  this  general  pursuit  of  broad  intelli- 
gence as  to  health  problems,  a  specific  and  definite  exami- 
nation of  the  child  problem,  admits  of  no  question.  It 
seems  best,  therefore,  that  a  distinct  bureau  in  this  broad 
movement  should  be  secured.  It  is  true,  however,  that 
there  are  questions  of  immediate  importance  w^hich  need 
not  wait  for  this  extensive  investigation.  Among  these 
questions  is  child  labor.  As  a  definite  factor  in  our  social 
economy,  the  iniquity  of  its  existence  is  enormous.  There 
is  inherent  in  it  the  same  ethical  stigma  that  there  is  in 
slavery  or  polygam}^  or  in  any  other  widespread  national 
moral  obliquity.  It  ought  not  to  exist,  and  the  intelligence 
and  effort  of  all  right-minded  citizens  should  be  committed 
to  its  extirpation. 

There  are  questions,  it  is  true,  which  are  open  to  reason- 
able difference  of  opinion.  What  constitutes  the  proper 
age  for  labor?  What  are  justifiable  considerations  in  deter- 
mining customs  of  labor  ?    These  are  appropriate  studies  for 


26o  HENRY     BAIRD     FA  V  ILL 

a  health  bureau.  Those,  however,  are  outlying  territories. 
The  plain  unvarnished  proposition,  that  children  shall  bear 
the  industrial  burden  of  this  people,  can  not  much  longer 
be  countenanced. 

My  privilege  to  address  this  meeting  comes  through  my 
connection  with  the  warfare  upon  tuberculosis.  Could  one 
come  from  a  territory  more  deeply  concerned  with  this  issue  ? 
Where  is  found  the  safet}^  of  any  individual  against  tuber- 
culosis? In  physique.  Where  is  laid  the  foundation  of 
physique?  In  childhood.  Where  bear  the  heaviest  the  bur- 
dens of  bad  hygiene?  In  childhood.  Where  concentrate 
most  the  direct  forces  of  infection?  In  childhood.  So  far 
as  tuberculosis  is  concerned,  there  is  no  hope  for  the  race 
until  the  territory  of  childhood  has  been  fortified.  History 
should  teach  us  to  be  without  surprise  that  a  great  people 
can  have  gone  on  to  such  development  with  so  little  fore- 
sight. 

Foresight  is  a  rare  combination  of  qualities,  a  joining 
of  vision  with  judgment ;  an  attribute  of  maturity ;  a  power 
by  no  means  universally  vouchsafed  to  men.  Myriads  of 
people  see  the  menace  of  an  iniquity,  and  fainthearted  turn 
aside  with  a  feeling  of  impotence.  Recognition  of  the  diffi- 
culty without  conviction  as  to  the  moral  obligation  which  it 
implies,  accomplishes  nothing.  Under  the  guise  of  conserv- 
atism masquerade  indifference,  timidity,  and  self-interest. 
True  conservatism  is  concerned  only  with  genuine  progress, 
hesitates  only  at  mistakes,  may  be  wisely  quiescent,  but 
never  supine.  It  is  curious  that  foresight  and  conserva- 
tism having  so  much  purpose  in  common  should  be,  in  fact, 
so  divergent  through  the  major  part  of  their  respective 
paths. 

In  social  development  the  struggle  is  always  between 
those  who  have  vision  and  those  who  have  caution.  In 
this  alignment,  the  forces  of  caution  under  the  conception 
of  prudence  receive  very  exaggerated  recognition  and  sup- 
port.    Those  who  have  vision  and  imagination  command 


M  !<:  I>  J  (    1  N  l<;      AND      IMIULIC      IN':  A  LIU  261 

undue  criticism  and  discredit.  The  time  has  come  to  act 
in  behalf  of  the  child,  and  those  who  sec  must  dominate 
those  who  fear  to  move,  and  to  this  end  all  sympathetic 
forces  must  be  combined.  That  there  should  be  any  difTcr- 
ence  of  opinion  as  to  the  imperative  need  of  properly  rearing 
and  protecting  the  children  of  the  nation,  is  unthinkable. 
In  fact  there  is  no  such  difference  of  opinion.  The  thought 
of  those  who  think  at  all  is  unanimous  upon  this  subject. 
The  problem  is  how  to  combine  the  insight  c^f  those  whose 
sympathy  has  reached  the  root  of  the  matter,  with  the  effec- 
tiveness of  those  who  have  the  courage  and  ability  to  deal 
with  it.  These  forces  can  only  be  combined  under  condi- 
tions which  satisfy  both.  There  must  be  a  broad  and 
evolved  policy  of  correction  and  protection.  There  must 
be  a  convincing  mass  of  accurate  information.  So  far  as 
appears,  nothing  offers  to  satisfy  these  requirements  but  a 
National  Bureau  devoted  to  the  welfare  of  the  nation  as 
represented  in  the  growing  child.  We  hesitate  not  at  all  in 
adding  our  influence  to  the  movement  in  that  direction. 


262  HENRY      BAIRD     FA  V  ILL 


Delivered  before  Alumni  of  Rush  Medical  College,  June   i,   1909. 
Printed,  The  .Bulletin  of  the  Alumni  of  Rush  Medical  College,  June,  1909. 

MEDICINE  IN  THE  SCHEME  OF  CONSERVATION 

FOR  various  reasons  I  have  accepted  with  unusual 
eagerness  the  invitation  of  your  committee  to  address 
this  alumni  body.  Chief  among  these  is  the  fact  that 
the  membership  of  this  body  is  less  homogeneous  than  that 
of  most  bodies  with  which  one  has  an  opportunity  to  confer. 

One  consequently  encounters  a  more  diverse  opinion  as 
to  the  questions  touched  upon,  and  is  insured  a  hearing 
upon  the  particular  phases  of  a  subject  which  he  wishes  to 
emphasize. 

It  must  be  clear  to  all  of  us  that  medical  problems 
in  general  derive  their  importance  and  significance  from 
the  conditions  to  which  they  are  humanly  related.  The 
abstract  problems  of  science  are  identical  throughout  the 
world.  The  relation  of  applied  science  to  its  point  of 
application  determines  all  practical  use. 

The  time  has  come  when  scientific  knowledge  and 
thought  is  virtually  uniform  the  world  over.  The  utilization 
of  knowledge  is  still  defined  and  more  or  less  circumscribed 
by  local  conditions.  In  our  calling  we  realize  that  there 
is  a  marked  difference  in  the  characteristics  of  medical 
practice  according  to  the  density  of  the  population  in  the 
communities  in  which  it  is  practiced.  Considerations  which 
are  of  the  utmost  importance  to  the  country  physicians  are 
quite  negligible  in  the  city,  and  conditions  in  the  city  which 
modify  the  possibilities  of  medical  activity  are  scarcely 
comprehensible  to  the  physicians  whose  practice  lies  out- 
side. We  are,  however,  one  profession,  with  one  motive 
and  one  destiny,  and  it  is  indispensable  that  we  come  to  see 
our  calling  in  its  broadest  aspect,  and  that  we  exercise  it 
upon  grounds  which  are  fully  tenable. 

If  we  approach  the  solution  of  our  problem  from  the 


M  l<;  I)  I  (    I  N  !<:      AND      I'  li  15  I.  I  (       II  I-.  A  L  I   II  263 

narrow  standpoint  of  self-interest,  no  matter  how  just  our 
motive,  we  shall  have  a  view  too  restrieted  to  be  valuable. 

If  we  a])proa('h  it  from  the  stjindj^oint  of  any  especial 
interest,  we  shall  find  the  same  limitation  of  vision  and  the 
same  danger  of  insecure  footing  and  lack  of  comprehension. 

This  is  a  day  of  generalization.  There  never  has  been 
a  time  in  the  history  of  this  country  when  the  tendency 
to  strike  sound  foundation  has  been  as  pronounced  as  it 
is  now. 

The  thought  of  large  thinking  men  is  perhaps  no  deeper 
nor  wiser  than  in  ages  past,  but  the  number  of  minds  that 
are  thinking  earnestly  upon  subjects  involving  the  common 
weal  has  increased  enormously.  With  wonderful  accord 
men's  minds  are  becoming  constructive  and  conservative, 
and  it  is  a  noteworthy  fact  that  even  the  terms  "con- 
structive and  conservative"  have  taken  on  new  meaning. 

To-day  it  is  quite  conceivable  that  a  constructive  policy 
may  involve  a  primary  destruction,  and  a  conservative  effort 
necessitate  most  radical  subversion  of  existing  conditions. 
All  of  this  it  is  necessary  to  consider  deeply,  lest  we  be 
carried  away  by  enthusiasm  or  buried  in  prejudice.  It  is 
necessary  that  thoughtful  men  and  women,  even  though 
engrossed  of  necessity  in  personal  affairs,  deliberately  and 
intentionally  devote  themselves  to  investigation  and  agi- 
tation of  questions  with  which  the^^  are  specifically  fitted 
to  deal. 

It  is  in  the  belief  that  the  members  of  the  medical  pro- 
fession are  in  position  most  thoroughly  to  know  and  most 
efficiently  to  deal  with  certain  questions,  that  leads  me  to 
address  you  to-night. 

You  have  heard  used  frequently  and  authoritatively  the 
term  "Conservation."  You  have  heard  it  applied  to 
water-wa3's,  forests,  mines,  power,  farm-lands  and  fertility, 
and,  in  fact,  to  every  department  of  human  industry'"  and 
commonwealth.  Yet  least  of  all  has  been  said  about  the 
most  important  element  in  the  whole  problem. 


264  HENRY     B  A  I  R  D     F  A  V  I  L  L 

Whether  one  adopts  as  a  standard  of  judgment  happi- 
ness or  longevity,  industrial  efficienc^^  esthetic  develop- 
ment or  morality,  the  factor  that  stands  beyond  all  question 
as  of  first  importance  is  health. 

It  is  too  obvious  to  need  discussion,  that  in  the  early 
history  of  society,  preeminence  was  determined  almost 
entirely  by  preponderance  of  health  or  vigor.  Physical 
prowess  was  the  means  to  social  domination,  and,  hence,  for 
all  that  period  of  advancing  social  structure,  bodily  strength 
was  at  a  premium  and  natural  conditions  were  operative. 

It  is  probably  equally  true  that,  in  the  successive  stages 
in  the  development  of  society,  bodily  and  mental  vigor  were 
the  essential  factors  in  the  marvelous  achievements  of 
modern  times.  With  the  advance,  however,  of  what  we 
call  civilization,  the  processes  of  natural  selection  neces- 
sarily and  very  markedly  become  modified,  with  the  result 
that  bodily  vigor  loses  its  immediate  and  obvious  relation- 
ship to  success. 

The  field  of  mental  achievement,  related  particularly  to 
industrial  development,  provides  a  very  different  footing 
for  the  various  elements  operating  therein,  and  we  find  to 
our  chagrin  that  we  have  reached  a  point  where  individual 
vigor  can  be  apparently  ignored  and  where  aggregations  of  • 
individuals  supply  by  their  mass  the  momentum  which 
formerly  resided  in  high  individual  quality. 

It  is  not  material  at  this  moment  that  such  an  economic 
philosophy  is  fallacious.  The  fact  is,  that  our  industrial 
life  is  built  upon  that  foundation.  Why  conserve  the  in- 
dividual when  the  supply  is  unlimited?  In  nature  the 
most  luxuriant  growth  only  just  precedes  decay,  and  the 
question  before  the  world  is  rapidly  becoming  how  to  con- 
serve the  products  of  intelligence  and  civilization  before 
the  process  of  rot  becomes  established. 

It  is  true  that  the  intelligence  of  the  last  century  or  two 
has  very  markedly  increased  the  average  longevity  of  the 
race,    but   it   is   equally   true   that,    corresponding   to   that 


M  K  D  I  C  I  N  FO      AND      I'  (J  15  I,  I  (        III,  A  1,1   11  265 

lonj^cvily  and  p(jLcntial  cfiicicncy,  there  is  an  inerease  of 
dependence  and  social  defectiveness  of  overpowering  im- 
portance. 

Tt  would  be  far  from  the  truth  to  inij^ly  that  the  ignor- 
inj^  of  health  conditions,  i)ublic  (;r  individual,  is  the  prox- 
imate cause  of  all  this.  (Jbviously,  our  whole  economic 
conception  is  faulty  and  distorted,  but,  no  matter  how 
strictly  any  particular  aspect  may  be  economic  rather  than 
physical,  no  matter  how  distinctly  an  outgrowth  of  indus- 
trial struggle  a  given  condition  may  appear,  the  path  by 
which  the  error  invades  the  social  structure  and  threatens 
its  destruction  is  almost  invariably  through  the  physical 
health  of  the  people.     What  is  being  done  about  it? 

Excepting  the  effort  of  what  we  may  call  the  specialist 
in  public  health,  the  world  has  gone  on  as  though  health 
were  automatic,  perennial,  and  perpetual.  Civilization  has 
created  a  new  world  in  which  we  live  and  has  with  wonder- 
ful complaisance  left  us  to  adapt  ourselves  to  it.  The  fact 
is,  that  what  might  be  called  natural  conditions  nowhere 
exist,  but  in  place  of  them  are  all  conceivable  degrees  of 
departure  therefrom. 

Whether  human  beings  withstand  the  conditions  of 
civilization  well  or  ill,  is  a  matter  of  circumstance.  So  far 
as  the  whole  public  is  concerned,  it  is  of  no  moment;  con- 
scious, coherent  plan  to  secure  this  adaptation  exists  only 
in  spots.  The  health  of  the  public  is  adrift  and  the  subject 
of  innumerable  vicissitudes. 

The  importance  of  meeting  this  question  is  beginning 
to  dawn  upon  our  civic  mind.  Almost  abruptly  the  con- 
sciousness of  its  magnitude  has  awakened.  Millions  of 
people  are  involved  in  this  consideration,  casual,  ignorant, 
and  helpless  upon  this  ground.  The  foundation  of  indus- 
trial life,  commerce,  and  social  development  is  at  stake. 
How  well  do  we  see  it?  At  last,  darkly,  but  "indeed 
revealed." 

The  greatest  subject  in  the  whole  conservation  movement 


266  HENRY     BAIRD     FAVILL 

is  the  public  health.  Upon  whom  rests  the  obligation  to 
make  this  plain?  The  question  answers  itself,  but  is  the 
medical  profession,  in  confessing  its  obligation,  definitely 
moving  to  that  end?  In  certain  directions,  it  may  be  said 
that  it  is. 

The  organic  structure  of  the  profession,  as  it  has  de- 
veloped in  the  American  Medical  Association,  may  be  of 
the  highest  use  in  focusing  and  mobilizing  medical  forces. 
Even  now  its  public  health  functions  are  intelligent  and 
weighty.  But  let  us  not  forget  that  our  formal  organi- 
zation is  the  fruit,  not  the  root,  of  our  growth.  Let  us  not 
forget  that,  though  our  pride  be  in  the  fruit,  our  strength 
is  in  the  root. 

Let  us  not,  therefore,  invert  our  dependence  and  rely 
upon  "The  Association"  to  fulfill  our  obligations.  The 
root  of  the  matter  is  the  social  group:  the  practitioner, 
under  whatever  form  or  plan  he  works,  and  the  individuals 
to  whom  he  ministers.  It  is  under  this  conception  that  we 
can  recognize  identity  of  function  under  all  conditions. 
The  responsibility  of  the  practitioner  to  his  group  is  the 
idea.  Upon  that  ground,  how  do  we  stand  ?  What  is  that 
responsibility  ?  Is  it  a  fixed  or  a  changing  relation  ?  How 
well  do  we  meet  it? 

Am  I  right  in  assuming  that  there  is  such  a  thing  as  a 
practitioner  and  his  group  ?  I  think  there  can  be  no  ques- 
tion as  to  that.  The  practitioner  of  medicine  bears  a  closer 
relation,  on  the  whole,  to  the  people  amongst  whom  he 
practices  than  any  other  man.  The  conditions  of  his  asso- 
ciation are  peculiar,  intimate,  and  authoritative.  By  no 
perversion  of  his  social  sense  can  a  true  physician  accept 
the  idea  that  his  calling  is  merely  a  business.  He  is  essen- 
tially a  minister  whose  obligations  are  perfectly  clear.  To 
mitigate  human  misery  is  the  purpose  of  his  life.  The 
question  I  wish  to  propound  is.  How  intelligently  and 
how  comprehensively  do  we  grasp  the  possibilities  of  our 
vocation  ? 


MEJJICINE     AND      IM;  H  L  I  C      H  1<:  A  I.  IH  2O7 

As  men  dcvclo])  in  the  medical  profession,  through  eon- 
taet  with  the  problems  of  health  and  disease,  and  through 
experience  fraught  with  burdensome  disappointment  and  a 
frequent  overpowering  sense  of  futihty,  they  come  almost 
inevitably  to  the  conclusion  that  the  great  medical  achieve- 
ments of  the  world  are  destined  to  be  found  in  the  field  of 
preventive  medicine. 

One  need  only  canvass  his  day's  experience  with  intelli- 
gent analysis  and  honest  judgment,  to  reach  the  conclusion 
that  he  could  have  achieved  a  hundredfold  more  by  way 
of  prevention  than  he  ever  achieved  by  way  of  cure,  if  he 
could  have  controlled  antecedent  conditions. 

If  this  simple  conclusion  of  a  mature,  sane  medical  mind 
is  sound,  the  premises  of  the  future  development  of  medicine 
are  already  defined.  It  becomes  a  question  of  controlling 
antecedent  conditions.  I  readily  concede  the  enormous 
difficulties  in  this  conception.  I  see  as  clearly  as  anyone 
the  intricacy  with  which  all  social  problems  are  interwoven 
into  this  question.  No  amount  of  complexity  or  difficulty, 
however,  in  the  least  degree  qualifies  the  truth  or  importance 
of  this  view. 

The  health  of  the  people  is  the  outgrowth  and  expression 
of  their  habits  of  Hfe,  and  their  habits  of  life  are  conditioned 
upon  facts  imposed  upon  them  by  our  social  organization, 
which  they  have  neither  the  intelligence  to  comprehend 
nor  the  power  to  control.  Are  we  ph^'sicians  in  any  better 
position  respecting  this? 

Although  it  is  obvious  that  as  individuals  our  control 
is  of  necessity  limited,  there  is  no  limit  upon  our  powers 
of  comprehension.  There  is  no  bar  to  our  grasp  of  the 
situation.  There  is  no  excuse  for  our  failing  to  realize  its 
importance.  There  is  great  opportunity  for  us  to  act  as 
educators.  The  only  thing  which  we  need  is  the  thing 
which  we  too  generally  lack,  the  spirit. 

When  shall  we  reach  the  point  when  our  primary-  mo- 
tive is  a  desire  to  control  the  conditions  under  which  people 


268  HENRY     B  A  I  R  D     F  A  V  I  L  L 

live?  Until  we  have  attained  that  merit,  and  until  we  think 
and  act  under  that  motive,  we  are  in  a  measure  an  apology 
for  a  profession. 

Two  things  are  essential  to  our  development  in  this 
direction.     The  first  is  solidarity  in  the  profession. 

I  am  willing  to  consider  the  merit  in  organization  and 
solidification  in  any  group  of  workers  upon  the  basis  of 
self-interest.  Self -protection  is  essential  to  growth  and 
growth  is  the  essence  of  efficiency.  But  that  self-interest 
should  be  our  final  and  most  imperative  motive  is  un- 
thinkable. Unless  our  organizations  proceed  toward 
altruism  and  social  regeneration,  they  will  crumble  and 
become  a  mockery.  Already  the  day  when  we  cry  out  for 
organization,  that  we  may  be  more  powerful  for  our  own 
advancement,  is  past. 

To-day  the  shibboleth  of  medical  organization  is  the 
public  weal.  If  we  seek  power,  it  is  to  that  end,  and  what- 
soever perverts  or  deflects  our  organic  being  from  that  course 
is  reprehensible  and  in  the  end  futile.  Hence,  our  solidarity 
is  essential  to  our  progress. 

Herein  lies  the  hope  of  the  individual,  that  he  may  fulfill 
his  obligation  to  himself;  that  he  may,  by  combination 
and  cooperation,  come  into  his  full  power  and  influence 
so  far  as  concerns  his  purely  medical  functions. 

The  second  essential  to  our  progress  is  cooperation  with 
all  corrective  social  forces. 

The  discouraging  complexity  of  the  practical  problems 
leads  us  unerringly  to  this  conclusion.  Conditions  of  liv- 
ing, in  their  relation  to  health,  no  matter  how  intelligently 
comprehended,  can  not  be  controlled  without  the  most 
radical  corrective  effort. 

It  is  idle  to  discuss  mental  or  moral  or  physical  health 
in  the  terms  of  a  slum.  It  is  wasteful  to  expend  unlimited 
money  on  hospitals  and  other  corrective  institutions,  while 
at  the  same  time  we  broaden  and  deepen  the  social  morass 
which  feeds  them.     It  is  immoral  laboriously  to  cut  down 


ME  Die  INK      AND      IMJiii^lC      III-.  A  1,1   H  269 

the  death  rate  of  infancy  without  assuming  the  responsi- 
bility for  childhood.  It  is  as  wron^  as  it  is  foohsh  to  fight 
for  child  life  and  li>'ii)i)iness  and  jjermit  the  social  struggle 
to  predestine  perdition  at  adolescence. 

All  of  these  things,  we  know,  are  inextricably  interwoven 
with  our  specific  problems  of  health.  They  are  things 
which  must  be  dealt  with  by  those  with  social  insight  and 
conviction.  Part  of  these  things  we  know  better  than  any- 
body. Can  we  upon  any  theory  avoid  the  responsibility 
for  our  part?  Obviously,  the  only  way  by  which  we  can 
come  to  our  full  measure  of  service  is  by  earnest  and 
intelligent  cooperation. 

The  time  is  already  here  when  to  be  only  a  practicing 
physician  is  a  discredit.  Not  only  has  the  medical  profes- 
sion to  furnish  its  full  quota  to  the  army  of  social  service, 
but  in  many  respects  it  must  point  out  the  way.  The 
pathology  of  society  is  as  much  the  function  of  the  medical 
man  as  the  pathology  of  human  disease. 

It  is  inevitable  that,  as  the  intelligent  community  traces 
back  conditions  step  by  step  to  their  causes,  the  offices  of 
the  medical  profession  shall  become  indispensable.  It  is 
by  this  path  that  the  medical  profession  wdll  come  into  its 
final  reward.  In  that  day  the  lack  of  authority  and  influ- 
ence, which  we  are  now  disposed  to  deplore,  will  disappear. 
We  shall  find  that  our  function  as  interpreters  of  life  will 
determine  our  position  of  usefulness  and  repute.  In  the 
meantime,  what  are  we  doing  as  practitioners?  Assuming 
that  our  scope  is  somewhat  limited  by  opportunity,  how- 
well  are  we  meeting  the  possibilities  which  are  before  us? 

Let  us  put  the  question  different^.  How  generally  are 
the  people  of  this  country  receiving  a  reasonable  measure 
of  benefit  from  medical  science? 

When  we  regard  the  marvelous  advance  of  medicine, 
and  the  things  which  have  been  and  can  be  achieved,  that 
are  real  and  permanent,  we  are  prone  to  be  impressed  -^-ith 
the  greatness  of  our  calling.     We  must  not  forget  that  the 


270  HENRY     BAIRD     FAVILL 

final  measure  of  our  greatness  will  be  the  breadth  of  dis- 
tribution of  medical  benefits,  not  isolated  demonstration. 
We  must  .not  forget  that  from  a  medical  standpoint  the 
benefits  of  science  must  not  be  confused  with  the  ability  to 
pay  for  them.  We  must  remember  that  the  overwhelming 
majority  of  our  people,  upon  the  basis  of  material  resources, 
would  be  denied  access  to  the  highest  medical  resources. 
We  must  approach  this  necessity  for  adjustment  open- 
minded,  and  see  not  only  what  is  lacking  but  invent  a  plan 
to  supply  the  deficiency.  It  may  be  that,  as  the  importance 
of  public  health  becomes  understood,  and  when  it  is  appar- 
ent that  public  health  underlies  all  social  development, 
the  State  will  assume  a  supervision  of  health  activities  as 
freely  and  actively  as  it  now  supervises  education.  What 
the  future  of  that  development  may  be  it  is  useless  to 
forecast,  but  long  before  that  comes  to  pass  the  profession 
will  have  to  do  its  work  better,  more  intelligently  and  more 
honestly  than  it  now  does. 

The  resources  of  medicine  can  not  be  applied  adequately 
in  all  directions  by  any  individual.  The  skilled  laborer  of 
the  medical  profession  is  the  specialist.  No  amount  of 
criticism  or  cavil  can  deprive  him  of  his  just  valuation. 
The  legitimate  criticism  upon  specialism  to-day  is  lack  of 
correlation  among  its  various  parts.  We  are  treating 
departments  as  though  they  were  entities.  We  are  dealing 
with  parts  unrelated  to  the  whole.  We  are  consequently 
falling  miserably  short  of  real  achievement. 

The  reasons  for  this  are  partly  crudeness  of  medical 
conception  and  partly  economic.  The  necessity  to  pay  for 
medical  service  as  we  now  conduct  our  affairs  means  two 
things:  First,  scientific  and  complete  therapeutics  are 
limited  to  the  very  few  who  have  large  resources.  Second, 
most  of  the  people  who  pay  for  service  receive  it  more  or  less 
fortuitously,  with  a  woeful  degree  of  haphazard,  determined 
largely  by  the  preponderance  of  symptoms  in  one  way 
or    another.     Though    they  may   receive  in  one  direction 


M  IC  D  1  C  1  N  !•:      A  N  IJ      I'  IJ  IM.  I  (       II  10  A  LI   II  271 

adequate  service,  rarely  can  they  get  a  well  rounded  diag- 
nosi.s  £ind  therapy. 

For  the  mass  of  people  who  receive  without  compen- 
sation, escaping  consequently  the  immediate  economic 
obstacle,  there  is  still  the  fatal  inadequacy  of  our  clinical 
methods.  Coordination  between  departments  is  almost 
unknown.  Intelligent  consideration  of  outlying  conditions, 
social  status,  food,  habitation,  clothing,  and  mental  and 
moral  conditions,   is  wanting. 

We  jjlan  on  doing  this  thing  or  that  thing  more  or  less 
well,  but  in  the  vast  majority  of  cases  with  the  utmost 
futility,  because  we  fail  to  couple  up  with  the  conditions  of 
the  problem  which  determine  the  final  success  or  failure  of 
our  undertaking. 

In  the  face  of  this  gloomy  picture,  what  is  the  outlook? 
What  is  the  future?     What  is  to  be  done? 

In  the  first  place,  that  I  may  not  waste  time  upon  the 
discussion  of  material  aspects,  let  us  demand  that  the  line 
between  those  who  can  and  should  pay,  and  those  who  can 
not  and  should  not,  be  drawn  scientifically  and  rigidly.  I 
do  not  wish  to  discuss  that  proposition  now.  Let  us  draw 
a  line  that  will  not  necessitate  absolute  pauperism  and 
dependence  in  order  to  get  proper  treatment.  Alillions  of 
self-supporting,  self-respecting  people,  w^ho  need  and  will 
need  medical  assistance,  could  not  pay  for  it  under  existing 
methods.  The  line  has  got  to  be  drawn  high  in  order  to 
adequately  serve  our  people. 

But,  aside  from  this  question  of  pay,  is  the  deeper  ques- 
tion of  medical  efTficiency.  Let  us  again  revert  to  our  social 
unit,  the  medical  man  and  his  group  of  clientele.  Can  he 
satisfactorily  minister  to  all  its  medical  wants?  Obviously 
he  can  not.  The  differentiation  in  practice  makes  it  impos- 
sible. Consequently,  for  ever}^  group  of  the  community 
there  must  be  a  group  of  physicians.  Automatically  and 
casually  that  is  now  true,  but  the  pay  question  again 
makes  it  largely  inoperative. 


272  H  E  N  R  Y     B  AI  RD     F  A  VILL 

The  practice  of  medicine  for  the  future  must  be  "team 
work."  Upon  some  sound  and  normal  basis  of  association 
physicians  of  different  skills  must  work  together.  The 
people  have  a  right  to  the  benefits  of  science,  and  I  do  not 
hesitate  to  say  that  they  are  not  receiving  it.  Once  more 
let  us  revert  to  our  method  of  procedure. 

The  best  work  of  to-day  can  be  done  in  a  good  workshop. 
The  tendency  of  good  individuals  and  good  groups  is  to  get 
into  workshops.  The  workshop  of  the  medi-cal  man  is  the 
hospital  or  dispensary.  We  have  discussed  at  length  who 
should  be  treated  and  who  should  be  refused  treatment 
under  these  phases.  How  deeply  have  we  discussed  and 
how  earnestly  have  we  felt  the  importance  of  the  question, 
How  generally  are  medical  practitioners  given  the  privi- 
leges of  a  good  workshop? 

Under  the  conception  which  I  am  advancing,  of  medical 
evolution,  this  is  the  burning  question.  If  the  unit  of  medi- 
cal efficiency  is  the  doctor  and  his  group,  and  combina- 
tion of  these  groups  of  doctors  and  their  groups,  then  are  we 
bound  to  furnish  to  those  groups  facilities  for  the  exercise 
and  development  of  their  powers. 

The  time  must  come  when  every  man  who  is  fit  to  prac- 
tice medicine  shall  be  deemed  fit  to  have  an  organic  relation 
to  a  hospital;  when  the  only  test  of  a  man's  eligibility  to 
hospital  opportunity  and  recognition  shall  be  his  willingness 
and  capacity  to  work.  Then  may  it  come  to  pass  that  a 
correlation  between  all  of  the  inside  forces  of  distinctly 
medical  type  will  bring  about  medical  efficiency,  and  then 
will  it  become  imperative  that  this  high  degree  of  medical 
efficiency  shall  not  be  nullified  by  failure  to  protect  the 
extra-medical  conditions  upon  which  depend  the  final 
results  in  the  social  mass.  Then  will  it  come  to  pass  that 
the  physician  will,  as  a  measure  of  self-protection,  self- 
development,  and  self-expression,  become  a  sociologist, 
and  while  cooperating  with  his  colleague  in  his  medical 
labor,  will  cooperate  with  his  community  in  its  social  needs. 


MICDICJNIO      AND      JM.JJLIC;      II  Iv  A  J.  I   U  273 

By  those  means  and  those  only  can  w(;  work  out  our  salva- 
tion. 

The  views  whicli  1  am  advancinj^  and  the  projects  which 
I  am  suggesting  are  neither  visionary  nor  remote.  We  are 
right  on  the  threshold  of  this  metamorphosis.  We  feel 
that  the  demonstration  has  been  made.  It  only  remains 
for  us  to  accept  the  plain  facts  before  us. 

Shall  we  drift  on  blindly,  following  the  method  of  our 
ignorant  and  empirical  days,  or  shall  we  dignify  our  mag- 
nificent science  with  an  enlightened  workmanship?  Obvi- 
ously, the  problem  is  ours. 


274  HENRY     BAIRD     FAVILL 


Delivered  in   behalf  of  the  National  Committee  for  Mental  Hygiene, 

Chautauqua,  N.  Y.,  August   ii,   1909. 
Printed,  The  Quarterly  of  the  Illinois  State  Association  of  Graduate  Nurses, 

May,  19 10. 

MENTAL   HYGIENE 

IT  is  most  embarrassing  to  bring  before  an  audience  of 
this  character  a  subject  which,  even  if  not  technical, 
is  so  foreign  to  the  usual  trend  of  thought  and  interest 
of  people  as  to  make  it  a  question  of  how  deeply  they  may 
be  impressed  with  its  pertinence. 

I  have  no  doubt  as  to  the  essential  importance  of  the 
subject.  I  have  no  doubt  as  to  the  extreme  relevancy  to 
the  personal  interests  of  the  members  of  this  audience.  My 
doubt  lies  in  my  ability  to  make  it  perfectly  clear  that  it  is 
so  important  and  so  relevant  as  to  be  worthy  of  your  earnest 
attention. 

I  am  assuming  on  the  part  of  the  members  of  this  audi- 
ence, a  sense  of  responsibility  as  to  social  conditions,  even 
such  conditions  as  you  have  had  no  part  in  creating,  and  of 
such  historic  and  traditional  origin  that  all  responsibility 
for  the  creation  of  these  conditions  is  far  removed  from 
you.  Nevertheless,  I  assume  and  assert  a  responsibility 
on  the  part  of  you  all,  over  their  correction.  The  imminent 
question  in  my  mind  is  whether  a  responsibility  which  is 
merely  collective  can  be  regarded  as  a  useful  or  effective 
power. 

This  awakens  the  reflection  as  to  the  habitual  irrespon- 
sibility of  masses.  It  merely  emphasizes  the  reason  which 
lies  back  of  the  maxim,  "What  is  everybody's  business  is 
nobody's  business."  The  fact  is,  that  conviction  is  an 
individual  matter.  It  is  only  by  establishing  conviction  in 
the  minds  of  a  sufficient  number  of  individuals  that  masses 
of  people  can  be  moved.  It  is  true  that  effective  work  re- 
sults are  the  outcome  of  mass  movement.     But  one  must 


MIODICINIC     AND     P  U  J5  L  1  (       H  l,  A  L  T  H  275 

maintain  that  individual  conviction  and  a  sense  of  personal 
oblij^jation  is  absolutely  necessary  to  the  mobilizing  of 
aggregate  interest.  It  is,  therefore,  upon  that  foundation 
that  I  am  about  to  undertake  to  awaken  in  you  a  sense  of 
the  importance  of  the  subject  which  T  present.  Before  I  get 
through  you  will  have  said  to  yourselves,  "What  can  we  do 
about  a  matter,  as  to  the  facts  of  which  we  know  nothing, 
with  which  we  are  not  in  touch,  and  which  is  not  a  matter 
of  personal  interest?" 

I  call  your  attention  to  the  fact  that  those  things  are 
true  at  the  outset  of  all  the  great  movements  which  are 
finally  dependent  upon  public  sentiment  for  their  prosecu- 
tion. The  fact  that  your  management  here  to-day  has 
established  so  large  a  department  devoted  to  the  discussion 
of  Mental  Hygiene,  shows  that  those  who  are  thinking  about 
the  subject  are  planning  to  mold  public  sentiment,  and  so 
far  as  my  effort  to-day  is  concerned,  I  am  here  for  presenting 
briefly  and  in  a  fragmentary  way  the  point  of  view  of  a  newly 
created  National  Committee  upon  Mental  H^^giene. 

Before  I  finish  I  shall  have  reached  the  conclusion  that 
the  solution  of  this  whole  matter  would  be  simple  if  we 
could  only  establish  what  we  are  in  the  habit  of  calling 
"right  living."  But,  I  call  your  attention  to  the  fact  that 
the  aflairs  of  this  world,  the  development  of  social  move- 
ments, the  arrangement  of  social  matters,  the  prosecution 
of  social  reforms,  does  not  move  from  such  a  broad  gen- 
eralization toward  particular  dispositions.  The  progress  of 
things  is  the  reverse.  Things  move  from  the  particular 
to  the  general. 

Improved  sanitation,  for  example,  is  the  war  cry  of  the 
health  authorities  all  over  the  world.  Yet  it  reaches  its 
results  by  taking  up,  one  after  another,  concrete  subjects  of 
importance  and  solving  them  in  the  light  of  sanitar\^  laws. 

One  crusade  effectively  carried  on  against  typhoid  fever 
will  do  far  more  than  years  of  precept  on  the  subject  of 
sanitation. 


276  HENRY     BAIRD     FAVILL 

So  it  is  with  personal  hygiene.  The  world  is  alert  and 
keen  upon  that  subject  to-day.  Yet  no  one  factor  has  been 
so  influential  in  establishing  convictions  and  habits  as  to 
personal  hygiene  as  has  the  warfare  against  tuberculosis. 
The  necessary  processes  in  combating  tuberculosis,  and 
particularly  in  preventing  tuberculosis,  have  illuminated  the 
subject  of  personal  habits  to  an  unparalleled  degree,  and 
hygiene  has  received  an  impetus  which  it  can  never  lose. 

So  it  is  with  various  conditions  of  society  in  which  defec- 
tive health  is  a  causative  factor,  we  find  that  the  warfare 
directed  against  the  specific  cause  of  ill  health  is  likely  to 
be  the  means  of  disposing  of  the  whole  social  problem 
involved. 

An  example  of  this  is  the  newly  discovered  disease  in 
this  country  known  as  the  "hook  worm  disease."  It  is 
found  that  this  intestinal  parasite,  known  commonly  as  the 
"hook  worm,"  is  prevalent  in  practically  all  of  the  inhabi- 
tants of  certain  regions  of  this  country,  particularly  in  the 
South. 

For  many  years  we  have  been  regarding  the  poor  whites 
of  the  South  as  a  people  delinquent,  defective,  and  more 
or  less  degenerate.  We  have  seen  their  way  of  living,  we 
have  seen  their  appearance,  we  have  seen  their  inefficiency, 
and  we  have  attributed  it  to  bad  habits  and  laziness. 

The  fact  appears  to  be  demonstrated  that  this  intestinal 
parasite,  common  in  tropical  and  oriental  countries,  but 
comparatively  unrecognized  in  this  country,  is  responsible 
for  this  whole  situation. 

The  peculiarity  of  this  disease  is  typically  represented  in 
our  conception  of  "white  trash."  Fortunately,  this  disease 
is  easily  curable,  and,  by  comparatively  simple  methods, 
preventable.  Before  long  you  will  see  a  tremendous  effort 
made  to  eradicate  that  parasite.  In  the  process,  that 
large  social  group  which  has  been  the  problem  of  the  South 
will  be  regenerated,  and  that  gained  by  progress  from  the 
specific  to  the  general. 


M  JO  I)  I  (;  ]  N  io    AND    I' r  I',  I,  I  (      III';  A  I,  III        277 

wSo  wc  shall  find,  with  regard  to  this  general  subject  of 
Mental  Hygiene,  that  our  deepest  conviction  and  our  strong- 
est impulse  will  come  from  a  study  of  those  specific  defects 
in  Mental  Hygiene  which  come  to  our  attention  in  con- 
nection with  the  grave  difficulties  of  the  world. 

I  am  going  to  talk  to  you  to-day  of  things  that  are  sad 
and  sober,  and  unattractive  —  quite  in  contrast  to  the 
buoyant,  courageous,  and  cheerful  words  that  are  familiar 
to  you.  This  is  the  seamy  side  of  Mental  Hygiene,  but  of 
the  utmost  importance  to  scrutinize. 

The  world  has  taken  note  of  all  these  great  social  ques- 
tions with  tremendous  energy  lately.  A  new  conception 
of  the  situation  has  been  created.  To  those  who  reflect,  it 
has  become  perfectly  clear  that  the  State  is  most  deeply 
concerned  in  this  matter.  For  generations  the  idea  of 
charity  and  philanthropy  has  been  dominant  and  more  or 
less  operative.     It  has  not  achieved  its  results. 

Now  the  conception  of  efficiency  has  arisen.  The  State 
has  come  to  realize  that  this  is  not  a  question  of  charity  or 
philanthropy,  but  a  question  of  self-preservation.  If  the 
State  is  to  progress  and  develop,  if  civilization  is  to  attain 
the  rewards  which  are  legitimately  due,  something  must  be 
done  to  eradicate  the  processes  of  decay  which  are  following 
along  with  the  processes  of  development. 

The  time  has  passed  when  w^e  can  comfort  ourselves,  in 
the  face  of  individual  destruction,  with  the  reflection  that 
individuals  are  plenty.  The  State  has  discovered  that 
efficiency  of  its  units  is  absolutely  essential  to  its  indus- 
trial and  social  progress.  Therefore,  the  tendenc}^  is  more 
and  more  manifest  to  make  matters  of  health  the  subjects 
of  governmental  attention.  From  another  point  of  view, 
this  is  of  the  greatest  importance. 

Ignoring  the  facts  and  principles  of  wholesome  life,  has 
created  an  enormous  army  of  delinquents  and  dependents 
which  is  yearly  increasing.  The  problem  of  institutional 
care  and  assistance  to  these  classes,  is  rapidly  becoming  so 


278  HENRY     BAIRD     FAVILL 

difficult  as  to  strongly  array  the  forces  of  government  upon 
the  line  of  prevention.  It  is  not  only  futile,  but  it  is  imbe- 
cile, to  create  with  one  hand  conditions  of  social  dependence, 
and  undertake  with  the  other  to  relieve  them.  Prevention 
is  the  war  cry  of  intelligent  publicists  in  every  direction. 

There  is  still  another  aspect  to  this  question,  of  deeper 
significance.  The  moral  integrity  of  the  State  depends  up- 
on the  health  of  the  public.  Widespread  physical  decadence 
means  moral  decay.  I  can  not  stop  to  elaborate  this  sub- 
ject, but  the  conditions  are  aggravated  and  the  outlook,  if 
not  alarming,  is  threatening. 

Out  of  these  considerations  I  derive  my  privilege  to 
bring  before  you  to-day  a  subject  of  the  greatest  import- 
ance. No  public  question  is  of  greater  importance,  no  sub- 
ject is  more  misunderstood  and  misconceived,  than  the 
subject  of  insanity. 

A  few  minutes  ago  I  spoke  of  a  public  movement  in  which 
you,  for  example,  could  have  no  interest.  With  regard  to 
this  subject,  I  know  that  that  is  not  true.  I  know  that 
there  are  scores  of  people  in  this  audience  who,  directly  or 
indirectly,  have  suffered  from  the  conditions  brought  about 
by  the  mental  unsoundness  of  some  one. 

There  is  hardly  a  family  which  does  not  touch  this 
territory  in  some  way.  Those  who  touch  it  at  all  closely 
and  consciously,  know  the  depth  of  siiffering  involved  in 
the  conditions.  I  have  said  that  this  is  subject  to  enor- 
mous misconception.     This  is  true  in  several  directions. 

In  the  minds  of  most  all  people  there  is  a  fatalism  as  to 
insanity.  It  is  commonly  believed  that  insanity  comes  on 
for  some  inscrutable  reason  necessarily  and  inevitably,  under 
given  conditions.  In  making  that  generalization,  so  far  as 
it  is  a  conscious  process,  people  utterly  fail  to  realize  that 
there  are  many  kinds  and  manifestations  of  insanity. 

There  are  some  forms  of  insanity  which  absolutely  need 
not  have  occurred.  For  example,  somewhere  from  10  to 
20  per  cent  of  all  the  insane  are  insane  as  a  latent  result 


MliDlClNlv      AND      I'll',  l,l(       III-,  A  I,  I   II  279 

of  syphilis.  Without  st()i)|)injj;  to  (Hscuss  the  onormous 
difficulty  of  that  ])ro])osition,  1  simply  wish  to  j joint  out 
the  fact,  that  in  that  ^'vou])  of  the  insane  there  is  nothing 
predestined,  nothing  inevitable,  nothinj^  hut  what  is  in  its 
essence  absolutely  preventable. 

The  next  group  in  this  class  is  due  to  alcohol.  From 
20  to  25  per  cent  of  the  insane  have  reached  their  mental 
unsoundness  as  a  more  or  less  immediate  result  of  the 
excessive  use  of  alcohol. 

,  Again  avoiding  the  discussion  of  that  great  social  prob- 
lem, I  point  out  to  you  that  there  is  nothing  inevitable  in 
this  class  of  insanity.  Every  bit  of  it  is  avoidable  by  the 
avoidance  of  a  perfectly  voluntary  indulgence. 

For  the  most  part,  the  general  public  believes  that 
insanity  is  incurable.  Once  insane,  always  insane,  is  the 
prevailing  thought  in  the  average  intelligent  person.  Yet 
this  is  very  far  from  the  truth.  Twenty-five  per  cent  of  all 
persons  admitted  to  a  hospital  are  discharged  cured.  An- 
other 25  per  cent  are  discharged  sufficiently  improved  to 
be  able  to  resume  life  under  conditions  of  reasonable  comfort. 

This  is  true  under  management  of  all  sorts,  good,  bad, 
and  indifferent.  How  much  more  than  this  w411  be  true 
under  intelligent  and  sympathetic  management,  the  future 
can  tell.  There  is  reason  to  believe  that  a  large  improve- 
ment upon  these  percentages  can  be  made. 

I  w^ant  to  call  your  attention  now  to  another  phase  of 
this  matter,  which  is  not  the  accurate  or  statistical  phase, 
but  is  the  individual  and  human  phase. 

Most  of  us  look  at  this  matter  in  its  aspect  of  developed 
disease.  We  say,  here  is  an  individual  ^vho  is  mentally 
unbalanced.  Deplore  it  as  we  may,  how^  much  do  we  really 
think  about  it?  Do  we  realize  the  piteous  path  that  an 
individual  has  had  to  pursue  before  getting  to  that  state  of 
mental  demoralization  which  we,  under  our  crude  concep- 
tions, call  insanity? 

Consider  the  t^^pe  of  people  who  go  insane.     Of  course, 


28o  HENRY     BAIRD     FAY  ILL 

many  of  low  mentality,  also  many  of  very  high  mentality, 
sensitive,  conscientious,  perhaps  religious,  punctilious,  re- 
fined, and  infinitely  susceptible  to  the  jars  and  hurts  of  life. 

Think  what  one  has  gone  through  in  reaching  this  state 
of  demoralization !  Doubts  and  questions,  conflict  and  scru- 
ples, self -accusations  and  fears,  suspicions  and  anxieties  and 
mental  and  emotional  crises  and  climaxes  without  number, 
before  that  brain  has  given  way  under  the  strain  and  racking 
of  this  internal  turbulence.  Nothing  in  life  is  more  pathetic 
than  a  true  picture  of  the  mental  struggle  of  him  who  has 
gone  through  this  path,  perhaps  knowing  whither  he  tended, 
conscious  that  he  was  losing  the  fight,  in  anguish  of  mind 
and  body,  in  the  face  of  conditions  which  he  felt  himself 
unable  to  cope  with. 

How  many  of  us  sympathetically  and  intelligently  travel 
that  path  with  that  unfortunate  when  we  are  making  our 
mental  estimate?  Naturally,  few  of  us,  because  so  few 
understand  it  at  all. 

Perhaps  the  most  radical  misconception  which  we  hold 
with  regard  to  the  insane  is  as  to  their  mental  operations. 
We  are  prone  to  think  that  because  they  are  insane  they  do 
not  feel  or  reason,  think  or  remember,  suffer  or  enjoy,  as 
we.  As  a  matter  of  fact,  every  one  of  these  things  they  do 
more  or  less  as  we  do;  sometimes  more  keenly,  sometimes 
less  keenly,  but  essentially  as  we  do.  The  difference  lies  in 
their  balance,  in  their  capacity  to  adjust  processes  to  proc- 
esses, in  their  ability  to  apply  corrections  under  judgment. 

This  lack  of  balance  perhaps  subjects  them  to  greater 
tortures.  The  philosophy  or  the  reason  which  a  sane  mind 
employs  to  assuage  or  mitigate  the  sufferings  of  life,  is  often 
denied  to  the  insane,  so  that  they  are  the  helpless  prey  of 
emotions  which  they  have  lost  the  power  to  control. 

It  is  of  the  utmost  importance  that  we  should  come  to 
realize  that  the  manifestations  of  the  insane  which  lead  us 
to  think  of  them  as  queer  and  abnormal,  are  not  manifes- 
tations of  incapacity  to  think  or  feel,  but  are  curious  mental 


M  lO  I)  I  (    [  N  l<:      AND      IMJIiLlf       IIIOALIH  281 

freaks  and  devices  which  Ihcy  cmi>loy  under  some  law  to 
us  as  yet  unknown. 

The  ])u1)h'(;  rind  Ihc  mcdicnl  profession  have  got  to  be 
educated  upon  this  point  until  we  have  reached  the  limit 
of  our  toleration  of  ignorant  procedures  which  amount  to 
barbarity. 

One  of  the  most  serious  difficulties  in  this  matter  is  the 
legal  aspect.  Under  our  present  method,  the  law  undertakes 
to  define  what  is  insane  and  what  is  not  insane.  There  is 
a  certain  justification  for  that.  The  abstract  idea  of  per- 
sonal liberty  and  personal  responsibility  on  the  one  hand, 
and  the  concrete  idea  of  personal  property  on  the  other, 
combined,  have  made  a  reason  why  the  social  relations  of 
this  subject  are  tied  up  in  legal  enactment.  So  far  as  those 
considerations  go,  that  will  probably  always  have  to  be. 
But  may  I  remind  you  that  essentially  that  has  nothing  to 
do  with  the  case? 

No  statute  can  define  insanity.  No  court  can  adjudicate 
the  problems  of  insanity  with  any  approach  to  completeness. 
We  have  got  to  go  far  behind  the  courts  in  reaching  for  the 
foundation  and  root  of  this  question  of  mental  disease. 
Unfortunately,  the  intervention  of  the  law  in  this  matter 
has  led  us  into  a  series  of  brutalities  which  we  shall  have 
hard  work  to  eradicate. 

Do  you  realize  that  the  great  majority  of  all  those  who 
are  committed  to  insane  hospitals  are  committed  by  a  legal 
process,  involving  more  or  less  painful  court  procedure? 
That  a  large  part  of  all  insane  have  in  the  course  of  their 
legal  commitment  passed  through  lockups,  jails,  or  police 
stations  ?  Think  of  the  infinite  cruelty  of  these  processes  as 
applied  to  those  suffering,  sensitive,  bewildered,  struggling 
souls ! 

The  correction  of  this  is  not  so  difficult.  It,  however, 
involves  the  next  point  that  I  want  to  call  your  attention 
to, — the  substitution  of  the  idea  of  a  hospital  for  the  idea 
of  a  lunatic  asvlum. 


282  HENRY     BAIRD     FAVILL 

You  have  heard  wdse  men  say,  that  if  you  would  take  a 
precept  of  conduct  every  day  and  repeat  it  time  and  again 
during  the  day,  you  would  distinctly  modify  your  character 
and  mold  your  disposition  in  accordance  with  it.  I  have  no 
doubt  that  is  true.  But  it  is  just  as  true  of  other  mental 
subjects. 

The  conception  of  a  lunatic  as^dum  has  so  stamped  itself 
upon  the  public  mind  that  it  is  practically  closed  to  all  of 
the  true,  sympathetic,  human  features  of  mental  disease. 
That  whole  mental  conception  involved  in  the  term  "luna- 
tic asylum"  has  got  to  be  swept  away,  and  substituted 
therefor  has  got  to  be  the  idea  of  hospital  and  hospital 
care,  treatment,  cure,  hopefulness,  effort. 

When  that  day  comes,  the  mental  attitude  of  the  public 
toward  insanity  will  have  changed.  The  day  will  come 
when  there  will  be  no  more  stigma  attached  to  a  broken 
mind  than  to  a  broken  limb.  Until  that  day  comes,  we  are 
doomed  to  fall  short  of  an  effective  dealing  with  this  subject. 
For  many  reasons  this  is  so,  but  for  this  reason  in  particular. 

The  greatest  vice  that  people  who  are  related  to  mental 
disease  practice,  is  the  vice  of  covering  it  up.  It  is  covered 
up  under  the  idea  of  disgrace,  an  unmentionable  subject. 
The  result  is  that  those  processes  go  on  past  the  point  of 
hopeful  intervention,  and  reach  a  stage  of  developed  insta- 
bility which  in  many  cases  never  need  have  been  reached 
if  they  had  been  more  frankly  dealt  with. 

So  it  is  going  to  become  necessary  that  we  develop  hos- 
pitals for  the  treatment  of  mental  disease,  more  intelli- 
gent and  more  sympathetic  than  we  now  have.  We  must, 
m.oreover,  have  in  every  general  hospital  a  department  for 
mental  troubles  which  arise  in  connection  with  general 
disease.  We  must  establish  a  method  whereby  the  progress 
of  the  afflicted  one  must  be  through  the  hospital  super- 
vision rather  than  through  the  police  supervision. 

These  things  which  look  so  difficult  can  all  be  accom- 
plished.    It  is  a  mere  matter  of  conception  and  adjustment. 


IVI  I-;  F)  1  C  I  N  i;      AND      IMJ  liL  I  (;      HI'.  AI.'IH  283 

ProgreSvS  is  being  made  of  the  most  hojjcful  sort  in  New  York 
State.     It  will  follow  along  raj)i(lly  in  other  direetions. 

Naturally  IIutc  should  exist  a  close  affiliation  between 
the  forces  inside  of  tht;  lios])ital  and  the  social  force  outside 
of  the  hospital.  There  should  be  a  coordination  between  the 
staff  which  treat  patients  in  the  hospital,  and  the  families, 
or  the  public,  or  the  social  workers,  or  whatever  groups  there 
may  be,  outside  of  the  hospital,  to  which  we  look  for  coop- 
eration. 

All  this  means  simply  that  we  humanize  our  institutions; 
that  we  get  a  sympathetic  touch  between  the  social  group 
and  the  technical,  medical  group,  which  will  make  all  move 
harmoniously  in  the  same  direction. 

It  is  evident,  from  this  line  of  reflection,  that  the  place  to 
begin  with  reference  to  mental  disturbance  is  at  its  earliest 
possible  manifestation.  I  would  say  in  infancy,  childhood, 
school  life,  during  adolescence,  the  education  of  the  child 
in  the  direction  of  stability,  balance,  obedience,  poise,  is 
fundamental  in  this  question.  We  shall  come  to  see  this  in 
time.     But  it  is  never  too  soon  to  begin. 

Those  who  are  engaged  in  teaching  realize  how  little 
assistance  they  receive  in  the  home.  Those  who  are  observ- 
ing teaching  realize  many  times  how  inadequate  is  the  ped- 
agogic force  in  these  broad  questions.  Both  must  be  im- 
proved. 

But  of  all  the  needs  which  this  country  has  or  will  ever 
have,  there  is  nothing  more  imperative  than  the  strengthen- 
ing and  up-building  of  the  teaching  force  of  the  public 
schools.  Understand  me,  the  public  school  force  is  just  as 
good  as  we  have  any  right  to  expect  under  the  way  we  deal 
with  it. 

The  future  will  see  a  broad,  liberal,  generous  provision 
for  the  education  of  the  young,  and  the  teaching  force  -unll 
respond  to  that  spirit,  and  can  not  possibly  improve  until 
that  spirit  shall  dominate. 

But  aside  from  this  question  of  school  education,  comes 


2S4  HENRY     BAIRD     FAY  ILL 

the  moral  and  ethical  training  of  average  social  life.  Are 
our  standards,  habits,  pursuits,  under  the  popular  momen- 
tum, good  or  bad?  Is  life  as  we  lead  it  calculated  to  create 
and  maintain  mental  and  moral  poise,  or  is  it  not  ? 

I  am  perfectly  willing  to  admit  what  is  contended,  that 
the  world  is  growing  better.  Is  it  as  much  better  as  the 
intelligence  and  insight  of  this  day's  civilization  ought  to 
have  produced? 

Without  attempting  to  argue  the  question  of  prevailing 
standards,  I  simply  wish  to  put  forth  the  proposition  that 
standards  can  be  judged  good  or  bad,  according  to  their 
influence,  direct  and  indirect,  upon  mental  and  moral 
stability.  It  reduces  itself  to  this  proposition.  Right 
living,  right  thinking,  and  right  feehng  will  practically  era- 
dicate this  question  of  mental  disturbance. 

Of  course,  this  is  in  a  sense  millennial,  but  as  I  have 
before  called  to  your  attention,  I  now  repeat  that  the  way 
to  reach  a  generalization  is  by  coherent  attack  upon  specific 
defects. 

And  the  next  question  is,  how  prevent  this  insanity?  I 
do  not  wish  now  to  stop  to  discuss  the  question  of  venereal 
disease  and  alcoholism.  Those  are  the  subjects  of  great 
social  effort  which  is  progressive  and  bound  to  prevail  to  a 
large  extent. 

But  in  these  other  conditions  of  essential  mental  disturb- 
ance without  outside  connections  of  poison  or  interference, 
how  preventable  is  insanity?  Nobody  knows  the  answer 
to  that  question  as  yet,  but  those  who  are  studying  this 
matter  most  deeply  are  convinced  that  if  the  right  con- 
duct with  the  individual  who  is  getting  "shaky"  could  be 
established,  a  very  large  part  of  the  insanities  could  be 
prevented.  And  this  means  not  only  kindly  effort  but 
intelligent  understanding,  accurate  interpretation,  expert 
analysis  of  the  mental  operations  in  question.  It  means 
a  sympathetic  relation  which  in  itself  is  very  difficult 
to   secure.     Nevertheless,    in    spite    of    the    difficulties,    it 


M  IC  I)  I  C  [  N  IC      AND      IM     H  I.  1  C      Hi:  A  LI   II  285 

is  clear  that   progress    must   be    secured   upon    that   Hne. 

The  tendency  of  all  of  us  is  to  ignore  or  discredit  mental 
peculiarities.  Every  careful  history  of  an  insane  person 
shows  a  series  of  incidents  which,  if  they  had  been  prop- 
erly apprehended,  would  have  brought  curative  influence 
to  bear  upon  the  individual  long  before,  perhaps  years 
before,  anything  was  done. 

We  have  got  to  take  these  questions  of  mental  pecu- 
liarity seriously,  and  seek  expert  advice  with  reference  to 
them.  We  have  got  to  create  a  body  of  experts  whose 
advice  can  be  sought,  far  beyond  anything  which  now 
exists.  By  that  very  process  of  taking  notice  of  early  mani- 
festations, we  are  going  to  establish  saner,  truer,  more 
wholesome  standards  of  living.  All  of  this  will  work  to- 
gether finally  for  public  sanity. 

Efforts  in  this  direction  must  not  be  merely  eliminative, 
they  must  be  constructive.  We  must  learn  the  law  of  men- 
tal growth  and  apply  it.  We  must  learn  the  law  of  moral 
awakening  and  adjust  it.  We  must  find  the  influence  of 
habits  upon  mental  and  moral  processes  and  build  them 
wisely.  All  of  this  is  the  territory  of  prevention,  the  ver\' 
essence  of  all  constructive  effort  in  the  world. 

And  now  the  question  would  be  very  pertinent,  for  whom 
am  I  speaking?     Why  am  I  here  to-day  addressing  you? 

Briefly,  it  happens  in  this  way.  A  man  in  Connecticut, 
by  the  name  of  Beers,  was  for  a  number  of  years  insane. 
He  was  confined  in  various  hospitals,  had  various  experi- 
ences, and  ultimately  regained  his  balance.  He  came  through 
that  experience  with  an  accurate  memor}'  and  an  acute  per- 
ception of  everything  that  had  happened  to  him,  a  clear 
recollection  of  all  the  perverted  mental  processes  that  he 
went  through,  a  keen  sense  of  the  misinterpretation  to  which 
mental  processes  were  exposed,  a  very  temperate  resent- 
ment at  the  unnecessary  hardships  and  brutalities  which 
he  experienced,  the  outgrowth  of  a  system  and  not  of  per- 
sonal default,  and  all  this  he  imparted  in  one  of  the  most 


286  HENRY     BAIRD     FAY  ILL 

remarkable  books  of  the  age,  "A  Mind  that  Found  Itself." 
With  tremendous  conviction  and  singleness  of  purpose 
he  has  devoted  himself  to  the  amelioration  of  social  condi- 
tions as  they  bear  upon  the  question  of  mental  integrity. 
He  has  formed  a  society  in  Connecticut,  which  is  doing 
effective  work. 

He  conceived  the  idea  of  a  National  Committee  which 
should  do  a  comprehensive  work  in  this  direction.  He 
selected  a  Board  of  Directors  from  all  over  the  country. 

I  am  here  speaking  a  word  in  behalf  of  that  Committee. 

A  proper  question  is,  what  is  our  program?  At  the 
moment  it  is  rather  indefinite,  and  yet  in  a  general  way  I 
can  say  to  you  what  we  propose  to  do. 

In  the  first  place,  we  need  money  to  carry  on  an  effec- 
tive work.  We  hope  to  get  that  from  some  source.  As 
the  next  step,  which  seems  logically  to  be  the  last  step, 
which  we  shall  probably  pursue,  we  propose  actively  to  take 
up  what  is  known  as  after-care  of  the  insane.  That  means 
the  establishing  of  relations  between  patients  who  are  about 
to  be  discharged  as  cured,  or  partially  cured,  and  their 
outside  work,  establishing  a  connection  which  will  continue 
a  wise  supervision  out  into  their  social  relations.  The  value 
of  this  is  two-fold. 

In  the  first  place,  its  tendency  is  to  prevent  relapse  by 
foreseeing  conditions  unfavorable  to  the  individual  and  pre- 
venting their  harmful  operation.  In  this  way  probably  a 
very  large  percentage  of  the  relapses  can  be  prevented. 

But,  more  than  this,  and  probably  far  more  important 
than  this,  will  be  the  relationship  which  becomes  thereby 
estabhshed  with  the  family  and  group  and  entire  social 
circle  of  the  individual. 

In  establishing  a  harmonious  relation  in  this  way,  there 
is  no  doubt  that  a  great  deal  of  impending  mental  disaster 
can  be  averted.  It  is  one  of  the  ways  by  which  early  con- 
tact with  mental  disturbances  can  be  secured. 

Please  realize  the  difficulty  on  this  point.      Supposing, 


M  IC  I)  1  (■  I  N  !•;      AND      IM'I'.  I.  If        III.  A  I,  11 1  2H7 

without  any  entering  wedge,  we  undertake  to  go  to  a  family 
which  wc  know  to  be  more  or  less  vulnerable,  and  say: 
"You  have  a  bad  family  makeuj),  your  family  history  is 
bad,  you  arc  all  liable  to  go  to  fjieces  mentally;  we  want  to 
fix  it."  Imagine,  if  you  can,  anything  more  im])Ossible  to 
accomplish  than  results  upon  such  a  basis. 

On  the  other  hand,  if  you  can  go  into  that  situation 
naturally,  carefully,  and  with  a  sympathetic  connection 
already  established  through  an  actual  patient,  there  is 
practically  no  limit  to  the  access  which  can  be  secured. 
Whatever  results  are  possible  from  such  early  access  can  be 
achieved.     Those  are  the  merits  of  "after-care." 

Next,  our  program  is  education,  spreading,  broadcast 
as  we  may,  correct  ideas  about  insanity,  mental  balance, 
mental  hygiene,  right  living.  A  sample  of  this  effort  is  my 
talk  to-day. 

And  next,  we  shall  attempt  to  effect  legislation,  to  so 
alter  the  laws  and  the  procedure  as  to  fit  in  with  this  funda- 
mental conception  of  mental  unsoundness. 

As  a  preliminary  to  that  legislation,  we  must  have 
popular  opinion.  Legislation  can  not  go  much  beyond 
public  opinion,  and  it  is  our  desire,  and  it  will  be  our  effort, 
to  create  public  opinion  as  fast  and  as  widely  as  we  may. 

And  now,  the  question  is.  What  do  we  want  from  you' 
The  answer  is  simple  —  merely  a  hearing,  merely  a  fair  judg- 
ment, as  to  the  soundness  of  what  we  set  forth,  merely  a 
sense  of  its  importance,  and,  growing  out  of  that,  a  con- 
viction as  to  your  relation  to  it. 

We  want  a  hearing,  and  we  feel  confident  that  as  a  result 
of  a  hearing  we  shall  found  an  individual  conviction  on  the 
part  of  practically  every  one  as  to  his  obligation  to  help 
where  he  can. 

I  do  not  hesitate  to  say,  that  of  all  the  great  public 
movements  that  are  going  on  for  the  correction,  the  amelio- 
ration, of  social  conditions,  there  is  none  more  important 
nor  more  deserving  of  vour  earnest  attention. 


HENRY     BAIRD     FAVILL 


Delivered,  State  Campaign  for  the  Prevention  of  Tuberculosis,  Trenton, 

N.  J.,  October  21,  1909. 
Printed,  special  report. 

UPON  WHAT  GROUND  MAY  THE  STATE  ASSUME 
THE  DIRECTION  OF  PUBLIC  HEALTH? 

OF  course  I  am  gratified  to  be  permitted  to  participate 
in  an  occasion  of  this  sort.  I  am  gratified  to  be 
enabled  to  give  the  sHghtest  word  of  recognition  and 
appreciation  and  admiration  to  those  who  have  labored  as 
volunteers  in  the  creation  of  this  public  work  as  far  as  it 
has  gone. 

I  should  be  a  little  bit  embarrassed,  perhaps,  to  come 
here  from  a  State  that  had  not  crossed  the  threshold  of 
this  subject  to  talk  to  the  people  of  the  State  which  had 
penetrated  much  farther  into  the  subject;  but,  after  all,  it 
is  a  common  cause,  and  whether  one  is  farther  ahead  than 
the  other  is  of  little  moment.  From  another  point  of  view 
I  am  on  more  familiar  ground.  I  am  on  the  ground  which 
is  being  agitated  by  the  question  whether  the  public,  that 
is  to  say,  whether  the  organized  forces  of  the  State,  shall 
take  over  the  activities  of  the  tuberculosis  campaign,  or 
whether  it  shall  remain,  as  hitherto,  in  the  hands  of  the  highly 
competent,  but  nevertheless  private,  individuals  who  have 
carried  it  on;  and  it  is  upon  this  phase  of  the  subject  which 
I  shall  speak,  and  I  shall  confine  myself  as  near  as  may  be 
to  this  question. 

It  is  quite  unnecessary  to  argue  that  any  enterprise 
in  this  country,  social  or  philanthropic  or  commercial,  is 
necessarily  a  governmental  function.  We  know  better 
than  that.  When  one  stops  to  regard  the  efficiency,  the 
enthusiasm,  the  unselfishness,  that  goes  into  the  voluntary 
work  directed  in  this  warfare  against  tuberculosis,  one 
knows  that  private  individuals  and  groups  of  individuals 
can  manage,  finance,  and  execute,  to  the  highest  degree  of . 


M  l<:  I)  I  (•  I  N  !•;      AND      IMIU.  I(;      III',  y\  I,   Ml  289 

efficiency,  the  operations,  for  instance,  of  a  tuberculosis 
warfare. 

One  knows,  moreover,  tliat  in  many  instances,  they 
can  do  it  better,  with  more  economy,  and  with  more  in- 
cisive intelligence  proba:bly,  than  is  at  present  fair  to  expect 
of  governmental  agencies. 

All  these  things  we  know  in  favor  of  the  private  organ- 
izations which  your  State  has  demonstrated  so  fully.  When 
we  stop  to  think  of  the  natural  history  of  this  thing  we  find 
how  these  movements  start.  The  need  is  first  evident  to 
an  individual  or  to  a  few  individuals.  The  vSpirit  of  social 
reform  starts  these  things.  A  group  comes  to  a  recognition 
of  the  importance,  and  before  you  know  it,  there  is  a  great 
mass  of  impulse  in  the  community  looking  toward  the 
supplying  of  this  great  need,  namely,  succor  and  prevention 
in  this  direction. 

Who  goes  into  such  a  thing?  Public  spirited,  high 
minded,  intelligent  citizens  go  into  it  first  in  a  heartfelt 
way,  without  the  slightest  possibility  of  gratifying  ambition 
or  of  fulfilling  any  self-interest.  They  carr}^  this  thing  on 
to  its  fullest  extent.  Does  that  measure  the  good  of  this 
movement  ?  Is  such  a  movement  started  by  private  citizens, 
and  carried  on  by  disinterested  people  in  the  community,  to 
be  measured  merely  by  administrative  efficiency?  Far  from 
it.  And  this  I  want  to  call  your  attention  to  as  of  impor- 
tance: These  movements,  these  organized  efforts  carried  on 
by  private  individuals,  upon  private  initiative,  represent 
the  very  highest  fruit  of  human  civilization.  They  are 
the  moral  expression  of  the  people,  and,  as  such,  they  have 
in  them  the  hope  of  the  future  for  this  people;  and  these 
considerations  are  not  to  be  ignored  when  we  come  to  con- 
sider the  difficulties  of  handling  the  machinery'  of  these 
things. 

It  is  true  that  most  of  these  movements  start  \\'ith  the 
idea  of  making  a  demonstration,  of  showing  what  can  be 
done  in  a  given  direction;  and  things  are  done  with  that 
11 


290  HENRY     BAIRD     FAVILL 

in  view.  Most  of  these  movements  have  an  undercurrent 
of  thought  in  them,  which,  if  it  were  expressed,  would  be: 
"We  will,  show  the  State,  we  will  show  the  government, 
what  to  do,  what  can  be  done,  and  the  government  will 
take  this  over."  That  is  the  undercurrent  that  is  present 
in  all  organized  movements  of  this  character. 

Money,  time,  energy,  intelligence,  public  spirit,  have 
been  poured  into  this  work  in  New  Jersey.  Great  things 
have  been  achieved.  Magnificent  things  have  been  ac- 
complished. It  is  perfectly  clear  that  the  people  that 
have  carried  this  work  on  so  far  are  perfectly  capable 
of  carrying  it  on  farther.  Moreover,  by  just  as  much  as 
any  group  of  the  people  has  been  self-charged  with  the 
responsibility  for  the  welfare  of  the  body  politic,  by  that 
much  has  the  body  politic  been  leavened  by  an  ethical 
perception. 

We  must  not  forget,  in  the  enormous  importance  to 
this  whole  movement,  the  participation  of  the  people 
voluntarily  and  primarily  in  the  movement.  Why,  then, 
with  the  theme  which  can  sum  up  like  that,  agitate  the 
question  of  turning  it  over  to  the  government?  I  confess 
that  there  are  many  misgivings  that  come  to  one  under 
those  circumstances.  One  hesitates  a  good  while  before  he 
would  willingly  sweep  aside  these  activities  and  turn  them 
over  to  mere  officialism. 

We  see  primarily  why  these  things  start.  We  find  that 
it  is  easy  to  start  a  small  movement;  that  it  is  easy  to 
start  it  and  develop  it  along  its  proper  lines  to  a  high 
extent;  and  therefore,  it  is  a  natural  way  to  start.  Thus 
the  efforts  of  private  organizations  are  able  to  make  a 
standard  of  activities  which  it  is  hoped  the  public  activities 
can  not  recede  from,  and  so  it  is  with  reference  to  this 
standardizing  that  there  is  a  great  deal  of  private  effort 
set  on  foot. 

Nevertheless,  the  question  always  is,  if  this  is  turned 
over  to  government  forces  will  the  standard  be  maintained  ? 


M  E  D  I  C  I  N  10      AND      I'  U  ii  L  1  C      II  E  A  L  l  II  29  ( 

Now,  tc'ikinj^  all  these  thin^^s  into  consideration,  tak- 
ing into  full  consideration  and  giving  full  weight  to  all 
these  things  which  are  perfectly  true  as  being  the  qualities 
inherent  in  private  philanthropic  operations,  one  is  forced 
to  the  conclusion,  after  all,  that  the  foundations  of  such 
organizations  and  the  foundations  of  the  work  done  by  such 
organizations  are  not  sufficiently  broad. 

ConvSider  for  a  moment  many  of  the  cjuestions  which 
are  of  importance  for  the  people  to  take  up  and  which  these 
organizations  attempt  to  take  up.  They  are  questions  not 
of  any  faction  or  section  of  the  people,  but  questions  of  the 
whole  people.  Let  us  confine  ourselves,  if  you  like,  to  the 
question  of  tuberculosis. 

There  is  no  person  who  is  not  menaced  by  tuberculosis. 
It  is  a  race  question.  It  involves,  in  point  of  time,  genera- 
tions.    It  goes  to  the  very  root  of  the  human  constitution. 

Can  any  plan  for  dealing  with  it  be  too  broad  or  too 
deep  or  too  permanent?  When  one  stops  to  think  of  that, 
when  one  considers  the  enormity  of  tuberculosis,  when  one 
considers  the  amount  of  grief  and  suffering  and  heartrend- 
ing life  that  is  involved  in  it,  when  one  considers  the  enor- 
mous vital  and  economic  price  that  is  paid  for  it,  when  one 
considers  the  mental  and  moral  and  physical  tribute  that 
is  paid  it,  can  anyone  doubt  for  an  instant  that  it  is  the 
business  of  the  State  ? 

What  the  State  can  do  about  it  is  a  question.  Let  us 
for  the  moment  put  aside  entirely  and  permanently  the 
idea  of  charity.  Let  us  wipe  out  the  question  of  charity, 
and  let  us  put  this  State  activity  upon  the  ground  of 
self-preservation.  Upon  that  ground,  what  are  the  limits 
that  can  be  imposed  upon  the  activities  of  the  State!" 
I  repeat,  the  grounds  of  the  private  organizations  are  too 
narrow,  and  they  are  too  narrow,  first,  with  reference  to 
the  question  of  stability.  Private  organizations  are  un- 
stable, in  respect  to  their  personality.  It  is  a  fact  well 
known  to  all  workers,  that  it  is  a  difficult  thing  to  recruit 


292  HENRY     BAIRD     FAY  ILL 

the  forces  of  these  private  organizations  with  individuals 
who  are  satisfactory.  This  in  spite  of  the  fact  that  the 
community  is  full  of  individuals,  but  there  is  no  correct 
and  sure  wa}^  of  assembling  them.  To  be  sure,  this  situ- 
ation is  being  proved  in  a  measure.  People  are  too  busy, 
and  it  drops  into  the  way  of  being  executed  by  experts, 
and  yet  what  do  experts  involve?  Experts  involve  money; 
they  involve  pay  of  salaries,  and  they  involve  large  amounts 
of  money  for  the  carrying  on  of  any  of  the  activities  — 
which  brings  us  to  the  next  element  of  instability;  that 
is  to  say,  the  pecuniary  element.  It  is  well  known  that 
the  pecuniary  factor  in  this  situation  is  a  difficult  one. 
Pecuniarily,  these  organizations  are  always  in  a  bad  con- 
dition. Nothing  is  more  deadly  than  that.  Nothing  is 
more  stifling.  There  is  no  such  psychological  drag  any- 
where as  to  have  a  doubt  and  uncertainty  as  to  whether 
you  can  possibly  get  money  enough  from  the  public,  no 
matter  how  generous,  to  carry  on  a  definite  line  of  work. 
It  goes  without  saying  that  if  there  is  money  in  the  com- 
munity, some  plan  should  be  found  whereby  that  money 
can  be  readily  and  certainly  found. 

Get  it  and  expend  it  without  taking  away  from  the 
skilled  workers  their  energy  and  system  and  their  inspira- 
tion in  the  struggle  to  raise  the  money. 

And  the  second  thing  that  I  would  call  your  attention 
to,  as  inadequate  in  the  foundations  of  our  private  sym- 
pathies, is  lack  of  authority.  Wherever  there  is  a  public 
activity  going  on,  there  comes  a  point  where  there  is  a 
clash  between  public  interest  and  public  prejudice.  I  do 
not  care  whether  it  is  a  milk-supply,  or  vaccination,  or 
plumbing,  or  housing,  or  juvenile  court,  or  tuberculosis; 
wherever  it  is,  there  is  a  clash  between  the  agencies  of  the 
activity  and  the  general  static  condition  we  call  public 
prejudice. 

Until  the  public  as  a  whole  assume  responsibility  for 
activities,  until  they  get  behind  these  movements  and  until 


M  li  D  1  C  I  N  I<:      A  N  IJ      I'  U  B  L  1  C      HEAL'IJI  293 

they  delegate  the  execution  of  lliese  movements  to  their 
home  agents,  this  question  of  a  clash  of  authority  is  never 
satisfactorily  settled,  and  as  long  as  it  exists  there  are  some- 
times insuperable  barriers  and  always  delays,  and  this 
question  of  authorities  renders  it  entirely  important  that 
we  should  have  a  strong  force  recognized  by  the  people, 
behind  the  ordinance,  whatever  it  may  be. 

And  the  third  thing  I  want  to  call  your  attention  to 
is  more  important  than  all,  and  that  is  the  question  of 
correlation.  The  farther  we  go  in  sociological  work,  the 
more  we  find  the  dependence  of  part  or  part.  It  does  not 
make  any  difference  where  you  start,  all  lines  diverge,  but 
are  inter-dependent;  whether  it  is  a  question  of  tuberculosis, 
or  school  rooms,  or  playgrounds,  or  child  labor,  or  factory 
conditions,  or  wages,  or  whatever  it  may  be,  those  ques- 
tions are  inextricably  bound  together.  And  the  difficulty  is 
that  unless  some  plan  can  be  found  whereby  these  activ- 
ities and  the  attention  that  is  devoted  to  them  go  along  in 
consecutive  and  coordinated  lines,  the  very  best  achieve- 
ment that  you  can  make  in  one  direction  is  rendered  more 
or  less  futile  by  lack  of  achievement  in  others;  and  it  is  for 
that  reason  that  a  broad  governmental  control  is  in  the 
highest  degree  desirable  for  the  correlation  of  the  things 
which  must  go  together  in  order  that  any  one  of  them  may 
succeed. 

Of  course,  this  seems  like  a  far  cry.  It  seems  as 
though  it  were  a  great  way  off  before  the  intelligence  of 
the  people  would  reach  a  point  where  it  would  grasp  and 
encompass  an  effective  plan.  But  in  the  meantime,  there 
is  no  reason  why  there  should  not  be  cooperation.  There 
is  no  reason  why  governmental  agencies  should  not  cooper- 
ate with  the  private  agencies  looking  to  the  time  when  they 
shall  be  taken  over. 

Now,  there  is  no  reason  why  —  I  am  not  talking  about 
the  particular  citizens  of  New  Jersey  this  minute,  but  in 
general  —  the  government  should  not  aid  with  money  these 


294  HENRY     BAIRD     FA  V  ILL 

private  organizations  that  are  found  to  be  effective.  There 
is  no  legal  reason  why,  no  reason  why  of  any  kind;  and, 
after  all,  money  is  not  the  chief  difficulty.  The  chief  diffi- 
culty in  these  matters  is  to  get  the  official  life  of  the  State 
awakened  to  a  point  of  responsibility,  awakened  to  the 
idea  that  something  must  be  done,  the  legislative,  admin- 
istrative officials,  et  al.  It  is  sympathy  that  is  lacking,  not 
money.     Money  comes  easily  after  sympathy. 

One  thing  more  is  this:  Suppose  that  we  could  this 
minute  turn  over  to  the  State  the  activities  of  these  private 
organizations.  Supposing  that  everybody  that  is  carrying 
his  burden  could  just  discharge  it  onto  the  State,  and  sup- 
posing the  activities  of  private  individuals  in  the  cause 
should  be  withdrawn.     The  loss  would  be  incalculable. 

I  do  not  hesitate  to  make  that  statement.  The  loss 
would  be  incalculable,  if  the  interest  of  the  people  who  are 
doing  this  work  up  to  this  time  were  to  be  withdrawn  by 
any  such  substitution.  Let  us  not  forget  that.  Is  there 
any  reason  in  theory  or  in  fact  why  official,  social  service 
should  have  a  strong  line  of  demarcation  from  non-official 
social  service?  I  say  no,  and  I  say  that  official  association 
with  non-official  boards,  non-official  advisers,  councils,  aux- 
iliary councils,  has  got  to  come,  in  order  to  conserve  the  con- 
science and  the  civic  intelligence  of  the  people  who  thus  far 
have  shown  themselves  so  abundantly  able  to  carry  the  bur- 
den. You  will  see  that  I  am  not  disposed  to  take  the  State 
as  a  dead  thing,  nor  as  a  mere  aggregation  of  people  and 
things.  I  am  told  to  take  the  State  as  an  idea,  the  expres- 
sion of  the  coordinated  choice  of  the  people,  and  its  function 
is  only  limited  by  its  relationship  to  those  purposes.  And, 
therefore,  we  are  in  hopes  that  the  government  will  see  that 
its  obligation  is  just  as  broad  as  its  opportunity,  and  we 
are  in  hopes  that  with  regard  to  public  health  matters  the 
government  will  discern  in  the  matter  the  opportunity  for 
a  comprehensive,  consistent,  cooperating  policy,  the  oppor- 
tunity to  justify  the  ideals  of  democracy. 


M  I-;  I)  I  (•  I  N  !•;     AND     I'  I    IM,  I  (       iii:ai,'iii         295 


Printed,  liducdlioiuil  lU- Moiilh/y,  Odolicr,  f<)()<). 

SHOULD   THE    PUIiLIC   SCHOOI>    \Ui   THE 
BULWARK   OF   PUBLIC   HEALTH? 

WIT\  1 1 N  a  montlT  there  was  held  in  the  city  of  Chicago 
a  National  Conference  on  Criminology,  conceived 
by  the  officers  of  the  Law  School  of  the  North- 
western University,  as  a  means  of  celebrating  its  fiftieth 
anniversary,  and  designed  to  consider,  primarily,  criminal 
law  with  reference  to  its  correction  and  reform. 

Incidental  to  this  purpose,  came,  as  a  matter  of  course, 
analysis  of  conditions  underlying  the  causation  of  crime  and 
delinquency.  If  the  deliberations  of  that  conference  could 
be  carried  to  their  legitimate  end,  the  conclusion  would  be 
reached  that  effective  dealing  with  crime  lies  in  prevention, 
and  the  further  conclusion  would  be  practically  unanimous 
that  the  pathway  to  prevention  lies  through  education. 

At  the  last  International  Congress  on  Tuberculosis, 
wherein  was  gathered  the  intelligence  of  the  civilized  world 
concentrating  its  power  upon  this  great  public  question,  it 
was  concluded,  as  it  has  been  concluded  before  and  since, 
that  the  ultimate  solution  of  the  problem  of  tuberculosis 
must  lie  in  the  territory  of  prevention,  and  it  was  and  is  fur- 
ther concluded  that  the  essence  of  prevention,  the  indispens- 
able factor  looking  thereto,  is  education. 

At  all  the  active  world  conferences  upon  political  con- 
ditions looking  to  the  betterment  of  the  social  structure 
and  a  higher  type  of  living,  invariably  and  unerringly  the 
line  of  analysis  runs  through  the  prevention  or  avoidance 
of  evils,  back  to  the  fountain  head  of  human  intelligence  — 
the  culture  of  the  human  mind. 

Finally,  and  most  impressive,  the  field  of  medical  science 
has  been  brought  under  this  illumination,  and  medical  in- 
telligence to-day  stands  firmly  upon  the  ground  that  the 
combat  with  disease  is  fundamentally  a  question  of  hygiene. 


296  HENRY     BAIRD     FA  V  ILL 

which,  being  interpreted,  means  a  question  of  prevention, 
and  this,  in  its  last  analysis,  means  a  question  of  education. 

This  universal  reference  of  the  great  problems  of  life, 
back  through  whatever  steps  may  be  involved,  to  the  train- 
ing of  human  minds,  that  is,  to  what  we  call  education,  is  a 
little  suspicious.  It  looks  as  though  the  tendency  of  this 
reasoning  were  to  get  back  to  a  generality  and  to  suggest  a 
result  more  or  less  unattainable  in  its  remoteness.  In  fact, 
to  some  extent  this  is  true,  and  in  so  far  as  it  tends  to  place 
the  responsibility  for  conditions  upon  antecedent  conditions 
at  the  moment  irremediable,  it  is  a  source  of  weakness. 

The  fact  that  to-day  we  face  conditions  which  had  their 
origin  far  back  does  not  in  any  sense  justify  our  neglect  of 
present  results,  nor  lessen  our  obligation  to  struggle  with  the 
morbid  conditions  which  we  find;  but  quite  beyond  the 
efforts  of  the  world  to  deal  with  its  social  diseases  in  their 
present  form  as  best  it  may,  lies  the  obligation  to  trans- 
form this  generalization  —  prevention  through  education  — 
into  a  militant  activity  which  shall  ultimately  achieve  the 
correction  of  our  social  errors. 

For  the  most  part  the  possibilities  of  education  are  con- 
centrated upon  the  education  of  the  young,  and  the  logic  of 
the  situation  leads  to  certain  conclusions  which  have  yet  to 
undergo  a  tedious  probation  before  they  become  effective 
convictions. 

One  may  view  the  progress  of  events  with  weariness  but 
not  discouragement,  with  intolerance  but  not  impatience. 
Under  this  broad  social  conception,  how  long  will  it  be  be- 
fore the  nurture  and  culture  of  the  child  will  be  regarded  as 
the  greatest  question  open  to  the  operation  of  human  intel- 
ligence? How  long  will  it  be  before  the  world  is  convinced 
that  the  greatest  of  all  professions  is  the  profession  of  teach- 
ing? How  long  will  it  be  until  the  spirit  of  the  public 
towards  its  educators  is  one  of  broad  and  liberal  sympathy, 
which  shall  place  them  socially  and  materially  upon  a  plane 
of  commanding  superiority? 


M  IC  IM  (    I  N  IC      AND      IMJ  |{  L  I  (        III':AI.'III  207 

I  refer  to  this  question  of  the  status  and  function  and 
recoj^nition  of  the  teacher,  not  for  the  gratification  of  voic- 
ing my  own  appreciation,  but  because  the  theme  which  I 
am  about  to  discuss  and  all  possibility  of  a  practical  bearing 
to  my  idea  is  predicated  upon  a  competent,  intelligent,  and 
progressive  pedagogic  body. 

My  belief  is  that  the  maintenance  of  physical  well- 
being  or  health  is  fundamentally  a  moral  f|ucstion.  In  this 
statement  I  do  not  mean  to  reiterate  simply  the  doctrine  to 
which  all  subscribe,  that  we  are  under  moral  obligation  to 
secure  and  maintain  in  our  children  the  best  possible  health. 
That  is  obvious  and  accepted,  and,  in  a  more  or  less  effec- 
tive way,  strived  for. 

What  I  wish  to  enunciate  is,  first,  that  the  moral  prog- 
ress of  the  race  is  dependent  upon  its  physical  well-being; 
second,  that  an  intelligent  building  and  maintaining  of 
health  is  a  function  of  character  and  inseparable  from  a 
healthy  morale. 

If  health  were  universal  and  automatic  and  the  social 
conditions  related  thereto  better,  it  would  not  be  so  easy  to 
discern  this  relationship  to  race  progress.  A  study  of  social 
conditions  as  they  are,  yields  the  most  convincing  proof  of 
the  enormous  importance  of  defective  health  in  the  caus- 
ation of  social  disease. 

It  is,  of  course,  to  be  admitted  that  industrial  conditions 
and  a  variety  of  inequalities  of  opportunity  and  capacity 
have  much  to  do  with  bad  health;  but  it  is  also  true  that, 
even  under  the  existing  law^s  of  society,  the  health  of  the 
people  could  be  vastly  better  than  it  is. 

Whatever  that  relationship  may  be,  analysis  of  the 
situation  shows  clearly  enough  that  poverty,  crime,  vicious- 
ness,  and  inefficiency  are  preponderatingly  due  to  defective 
physical  condition. 

The  bearing  of  this  is  co-extensive  with  human  pur- 
suits. In  infancy  we  have  learned  the  lesson  of  the  "bad" 
child ;  in  school  we  have  learned  the  lesson  of  the  backward 


298  HENRY     BAIRD     FA  V  ILL 

child;  in  sports,  the  incompetent  child;  in  the  factory  or 
workshop,  the  inefficient  hand;  in  asylums  and  almshouses, 
the  defective  individual;  in  the  courts,  the  habitual  crim- 
inal; in  the  saloon,  the  besotted  habitue;  in  society,  the  in- 
valid parasite;  in  business,  the  perverted  marauder;  in  the 
pulpit,  the  distorted  bigot;  in  the  schoolroom,  the  nervous 
critic  —  all  of  them  harking  back  to  a  foundation  of  imper- 
fect health  for  the  common  factor  in  explanation,  and  even 
in  extenuation,  of  their  faults. 

Statistics  are  open  to  interpretation  and  hence  not  to 
be  followed  too  closely;  nevertheless,  extensive  observation 
throws  much  light  upon  these  questions. 

In  the  great  cities,  broadly  speaking,  85  per  cent  of  the 
relief  extended  through  organized  charity  is  made  necess- 
ary by  sickness  and  accident.  Our  increasing  social  delin- 
quency, growing  out  of  povert^^  and  its  necessary  conditions, 
is  thus  directly  and  causally  coupled  with  ill  health.  That 
these  unfortunate  conditions  in  turn  produce  and  aggravate 
disease,  establishing  thereby  a  vicious  circle,  is  beside  the 
point. 

The  fact  upon  which  we  should  focus  our  attention  is, 
that  imperfect  health  is  an  effective  barrier  to  individual 
development  and  an  enormous  clog  upon  social  progress. 

The  impression  prevails  widely  that  ill  health  is  unavoid- 
able and  that  most  conditions  of  disease  are  not  only  in- 
scrutable, but  that  they  remain  at  a  certain  degree  of 
destructiveness  unaffected  by  human  endeavor  or  intelli- 
gence. This  is  positively  untrue.  The  average  duration 
of  life  has  increased  markedly  in  the  last  few  centuries,  and 
this  increase  is  noticeable  in  direct  proportion  to  the  prog- 
ress in  civilization  of  the  various  peoples  under  observation. 

This  is  true  in  vSpite  of  the  fact  that  the  conditions  of 
urban  life  operate  strongly  in  the  opposite  direction.  What 
the  showing  would  be  if  this  entirely  removable  incubus 
were  to  disappear  is  a  matter  of  conjecture,  but  enough 
is  known   to  warrant  us  in   saying  that  public  health  is 


MEDICINE     AND      l'i;i{|.I(       II  I,  A  I.  I   II  299 

susceptible  of  im])rovement  to  a,  very  j^reat  extent,  and 
the  sentiment  has  become  fixed  in  the  minds  of  students 
of  social  econoniy  llial  lliis  is  the  greatest  conservation 
field  that  is  before  us  to-day. 

It  appears  that  this  matter  of  adjusting  mass  conditions 
is  to  be  the  function  of  the  State,  and  it  is  consequently  im- 
perative that  all  of  the  factors  or  units  of  influence  should 
be  rapidly  and  effectually  alligned  in  furtherance  of  this 
governmental  control.  It  is  not  going  to  be  enough  that 
schools  be  brought  under  medical  inspection  and  organiza- 
tion on  the  basis  of  health.  The  most  that  can  be  accom- 
plished thereby  will  be  inadequate  to  meet  the  conditions. 
Habitation,  food,  and  habits  are  factors  of  equal  im- 
portance, and  the  real  and  ultimate  problem  of  the  school 
is  how  to  become  an  effective  influence  upon  this  outlying 
but  essential  territory. 

Is  it  too  much  to  anticipate  that  the  school  shall  become 
a  social  center;  a  reservoir  of  intelligence  as  to  living  con- 
ditions, into  which  shall  flow  streams  of  social  influence 
tending  to  universal  betterment,  and  from  which  shall 
emanate  the  laws  of  intelligent  living? 

Unless  we  conceive  an  entirely  new  machinery  so  re- 
lated to  our  governmental  structure  and  so  related  to  our 
child  nurture,  we  have  no  other  alternative  than  to  settle 
upon  the  school  as  the  proper  instrument  of  popular  culture. 
So  far  as  I  can  see,  no  better  instrument  can  be  desired. 
Our  machinery  exists,  and  what  we  now  need  is  inspiration. 
Where  shall  we  look  for  inspiration?  I  am  convinced  that 
it  is  only  to  be  found  in  widespread  opinion  as  to  values; 
in  the  deep  and  fundamental  conviction  on  the  part  of  an 
intelligent  minority  as  to  what  are  the  essentials  in  edu- 
cation; in  a  thoroughgoing  recasting  of  our  views  as  to 
what  the  State  owes  to  its  people,  that  is  to  say,  to  itself. 

Too  long  have  we  gone  on  under  a  conception  of  edu- 
cation that  aims  to  provide  a  child  with  a  minimum  amount 
of  information  looking  to  its  economic  independence,   and 


300  HENRY     BAIRD     FAVILL 

too  superficially  we  have  touched  the  problem  of  culture 
and  spiritual  development,  without  which  life  never  rises 
above  the  dead  level  of  material  existence.  Too  exclusive- 
ly we  have  concentrated  upon  simple  mental  acquisition 
more  or  less  rudimentary,  ignoring  the  great  forces  of  life 
which  are  sweeping  on  irresistibly  to  results  dire  or  benign, 
according  as  we  adjust  ourselves  to  them.  Far  too  uni- 
formly have  we  permitted  the  pressure  of  circumstances  to 
drive  us  to  the  illogical  position  that  education  of  the  child 
is  a  dual  process,  partly  to  be  done  in  the  school  and  partly 
to  be  done  in  the  home.  In  short,  educational  effort  in 
general  has  failed  to  conceive  the  development  of  the  child 
as  a  coherent  process,  to  which  it  is  bound  to  contribute  a 
comprehensive  sympathy  and  discriminating  judgment  as 
to  values,  and  a  firm  guidance  and  authority  expressed  in 
the  broadest  and  simplest  curriculum  that  can  be  made 
effective. 

I  beg  you  not  to  convict  me  of  ignorance  of  the  vast 
chasm  of  disappointments  which  is  suggested  by  the  fore- 
going stipulation.  The  danger  and  the  difficulty  in  the 
whole  proposition  is  expressed  in  the  term  "ineffective." 
Well  I  know  that  the  path  of  education  is  strewn  with  fail- 
ures of  good  intention,  initiated  in  this  spirit  and  wrecked 
upon  obstacles  presented  by  existing  conditions.  All  prog- 
ress is  like  that,  and  it  offers  not  the  least  reason  nor  excuse 
for  abating  one  jot  the  effort  to  find  a  way  out  of  the  dark- 
ness. For  the  most  part,  failures  have  been  legitimate  and 
foreordained.  Even  where  obstruction  has  been  due  to 
lack  of  vision  and  comprehension  on  the  part  of  that  mass 
of  the  community  known  as  the  intelHgent  class,  which  has 
dammed  the  spirit  of  pedagogy  with  the  odium  of  fad-ism, 
failure  has  been  logical. 

We  are  in  the  midst  of  a  material  age  in  which  an  eco- 
nomic problem  is  scrutinized  in  the  light  of  its  commercial 
relations,  and  the  preponderating  mass  of  people  who 
have  advanced  to   the  point   of  thinking   about   it   at   all 


MIOf)I(    INK      AND      I'  (I  I'.  1,1  (        lll-:AI.'Ilf  301 

have  advanced  only  to  the  j)oint  where  they  can  regard 
immediate  industrial  efficiency  as  the  sole  desideratum. 

When  the  iiiiiid  of  tlic  jjulilic  has  reached  the  point 
where  ultimate  life  efficiency  shall  have  equal  weight,  then 
may  the  public  school  have  a  clear  field  and  a  compre- 
hensive function.  To  this  end,  those  who  have  vision  must 
lead,  and  in  this  effort  their  foundation  must  be  broad  and 
deep  and  sound. 

It  is  from  such  premises  that  one  is  entitled  to  the  be- 
lief that  the  public  school  has  no  deeper  obligation  than  to 
assume  responsibility  for  the  physical  education  of  the  child. 
If  it  were  simply  a  process  of  decreeing  good  health,  this 
would  be  true.  If  it  were  a  laborious  process  of  working 
out  and  bestowing  good  health,  it  would  be  true;  but  where 
the  process  of  achieving  good  health  involves  the  operation 
and  integrity  of  every  mental  and  moral  fiber  in  the  in- 
dividual, this  obligation  becomes  overwhelming  and  para- 
mount. 

Let  us  not  be  misled  by  the  thought  that  the  child  is  a 
natural  animal,  pursuing  the  course  of  nature  and  adapting 
itself,  as  intelligence  growls,  to  its  environment.  Exception- 
ally this  is  true,  but  very  exceptionally.  Conditions  of  living 
are  artificial;  habits  are  imitative,  and  general  conceptions 
of  life  are  faulty. 

On  the  \vhole,  the  maintenance  of  sound  health  must  be 
a  conscious  process,  intelligent  and  intentional.  Does  this 
seem  to  foreshadow  a  burdensome  and  unattractive  mode 
of  living?  Surely,  to  be  constantly  considering  one's  health, 
the  pros  and  cons  of  conduct,  the  better  and  worse  of 
method,  and  the  good  and  bad  in  pursuits,  all  with  refer- 
ence to  one's  physical  well-being,  must  be  unwholesome, 
must  it  not? 

The  answer  to  that  query  is  simple.  It  depends  en- 
tirely upon  how  one  does  it.  One  can  do  that  thing  in  a 
way  to  make  life  so  unlovely  that  it  is  not  worth  preserv- 
ing.    One   can   magnify   luxurious   conditions   of   comfort, 


302  HENRY     BAIRD     FA  V  ILL 

the  solicitousness  of  precaution,  hair-splitting  definitions 
of  h^^giene,  superficial  trivialities  of  vanity,  to  the  point  of 
outrageous  and  disgusting  selfishness.  Better  by  far  that 
the  world  shall  go  on  and  find  its  solution  in  the  most 
unthinking  struggle  for  survival  than  that  that  spirit 
should  be  fostered  or  tolerated  as  a  phase  of  education. 

As  a  matter  of  fact,  the  very  falseness  of  this  conception 
determines  the  failure  of  such  an  effort.  No  health  was 
ever  achieved  upon  that  basis.  The  conception  is  wrong, 
the  purpose  is  wrong.  The  dominating  motive  under  this 
idea  is  timidity,  fear  of  ill  health,  and  avoidance  of  dis- 
comfort. It  is  essentially  a  negative  impulse,  unbalanced, 
querulous,  and  cowardly.  It  makes  people  dependent, 
victims  of  their  own  distorted  minds,  a  burden  to  the  strong 
and  a  prey  of  the  unscrupulous.  Perish  the  thought  that 
we  should  counsel  cultivation  of  that  sort  of  self-consid- 
eration ! 

The  idea  of  physical  integrity  glorifies  the  body  to  the 
point  of  willingness  to  make  the  sacrifices  necessary  to 
maintain  perfection.  I  think  the  word  "glorifies"  is  not 
too  strong.  I  speak  not  of  pride  of  bone  and  brawn,  of 
physical  prowess  or  beauty  or  skill;  all  of  these  are  of  it, 
but  not  it.  I  speak  of  that  sense  of  well-being,  courage, 
self-reliance,  hardihood,  and  harmony  with  nature  in  the 
individual  whose  physical  equilibrium  is  the  product  of 
intelligent  living  and  the  object  of  conscientious  attention. 
Herein  lie  power  and  freedom.  Are  these  not  a  foundation 
for  glory? 

Unusual  natural  endowment  is  no  necessary  part  of  this. 
Undue  physical  development  is  quite  apart  from  it.  That 
person  is  exceptional,  no  matter  what  his  natural  limitation, 
who  can  not  attain  the  physical  poise  necessary  to  this  great 
emancipation. 

I  fancy  I  hear  the  comment,  "That  is  not  physical  poise; 
that  is  mental  poise."     They  are  inseparable. 

It  is  true  that  inferior  physical  status  can  be  dominated 


M  10  I)  I  (    I  N  10      AND      I'll',  l,f(        III.  A  I.  11 1  303 

in  a  measure  by  menial  effort.  It  is  true  tliat  the  results  of 
physical  disabiHty  can  be  mitigated  by  spiritual  equilib- 
rium; but,  taken  h)y  and  large,  mental  activities  pay  tribute 
to  physical  condition,  and  physical  aberrations  dominate, 
deteriorate,  and  destroy  as  inexorably  as  do  other  physical 
and  chemical  forces  which  control  the  course  of  the  world. 

It  is  small  wonder  that  those  who  have  seen  and  ap- 
preciated the  maladjustment  of  life,  in  which  mental  and 
moral  instability  pla}'  such  a  part  and  permit  such  havoc, 
should  strike  at  this  point  as  the  root  of  social  disease. 

While  estimating  these  factors  at  their  full  and  true 
value,  those  who  know  this  subject  most  deeply  know  that 
there  is  a  territory  in  which  actual  and  demonstrable  forces 
play,  unconquerable  by  will,  uninfluenced  by  thought,  act- 
ing and  reacting  with  perfect  relation  of  cause  to  effect, 
which  are  the  product  and  logical  sequence  of  conditions 
antecedent  and  more  or  less  avoidable. 

The  educated  medical  mind  knows  this.  To  a  distress- 
ing degree  it  does  not  know  what  to  do  about  it.  Much  of 
the  physical  perversion  which  we  call  disease  is  terminal 
and  fixed.  Naturally,  then,  the  medical  mind  seeks  the 
sources  of  disturbances,  strives  to  detect  the  earliest  de- 
parture from  the  normal,  and  reaches  the  conclusion  that 
the  effective  effort  of  the  race  must  rest  in  maintaining  the 
normal. 

If  this  were  susceptible  of  mass  control,  and  if  we  could 
determine  and  define  the  canons  of  health,  adherence  to 
which  would  insure  the  health  of  all  the  people,  the  problem 
would  be  comparatively  simple.  To  determine  the  facts 
would  be  the  first  step.  To  establish  the  authority  neces- 
sary to  universal  observance  would  be  the  second  step.  So 
far  as  I  know,  neither  of  these  steps  has  been  suggested 
as  possible  by  any  careful  mind. 

The  detailed  facts  of  hygiene,  though  susceptive  of  some 
generalization,  are  essentially  individual,  and  an  individual's 
stud}^  of  his  equation  is  the  important  need. 


304 


HENRY     BAIRD     FAVILL 


Observance  of  detailed  and  intimate  modes  of  life  on 
the  part  of  an  individual  can  never  be  reached  by  edict. 
The  motive  and  authority  for  this  is  internal  and  comes 
only  in  response  to  consciousness  of  the  importance  and 
dignit}^  of  the  subject.  From  the  point  of  view  of  an 
educator,  therefore,  the  question  becomes  like  any  other 
question  in  education :  not  simply  what  material  to  present, 
but  how  to  secure  its  assimilation. 

All  teachers  know  the  subtle  evasiveness  of  the  child 
mind  in  the  face  of  coercion.  The  precept  which  a  child 
does  not  finally  incorporate  into  his  philosophy  is  lost. 
Mere  instruction  offered  to  the  young  as  to  laws  of  health 
is  almost  useless.  Here  and  there  a  general  principle 
hammered  enough  and  reiterated  enough  may  serve  as  a 
rallying  point  for  a  later  intelligence,  but  the  real  fabric 
of  education  is  woven  in  the  experience  of  daily  life.  So 
it  is  that  I  say  that  the  physical  education  of  a  child  must 
be  determined  by  something  that  is  basic,  by  a  receptive- 
ness  that  I  believe  can  be  furnished  only  through  evolution 
of  an  ideal  of  physical  development. 

Let  us  not  make  the  mistake  of  thinking  that  the  child 
and  the  adult  could  reach  this  result  by  the  same  path. 
The  adult,  if  he  reaches  this  conclusion  and  adopts  it,  does 
so  by  a  process  of  annexation,  belated  and  imperfect.  The 
child,  if  he  gets  it,  grows  it,  and  it  is  a  part  of  himself,  un- 
conscious, at  first,  and  largely  automatic.  Never  will  the 
result  for  the  child  be  achieved  until  the  adult  who  rears 
him  has  adopted  the  ideal.  To  you,  therefore,  who  are 
entrusted  with  the  young,  and  I  think  with  the  responsibility 
for  the  future  of  the  world,  I  make  this  earnest  plea:  that 
you  take  this  matter  at  its  full  value;  that  you  surround  it 
with  all  the  color  and  all  the  quality  possible  and  necessary 
to  its  attractiveness;  that  you  dignify  the  subject  to  the 
point  where  you  are  willing  to  give  it  commanding  im- 
portance in  the  curriculum  at  any  point. 

Assuming  your  acquiescence  herein,  what  is  necessary 


M  IC  I)  I  C  1  N  !•:      ANh      IMIULM       111,  A  LI   II  30.S 

to  do?  What  is  it  necessary  to  he?  Why  speak  of  "sacri- 
fices ncccssaiy  to  the  maintenance  of  health"? 

The  world  lives  not  hy  tlionj^ht  hut  l>y  imitation. 
Fashion  controls  the  activities  of  life  and,  curiously  enough, 
there  is  a  constant  mimicry  of  the  so-called  "classes"  by 
the  masses.  There  is  no  doubt  that  this  is  an  unconscious 
tribute  to  what  is  assumed  to  be  cultivated  intelligence. 
Nothing  better  expresses  it  than  the  keen  analysis  of  a 
laboring  man  whom  I  once  heard  exploiting  the  subject  to 
a  fellow  laborer,  who  was  commenting  adversely  on  some 
fashionable  people  who  were  dining  out  in  public  view. 
With  a  fine  irony  he  rebuked  his  companion,  saying,  "Jim, 
they're  layders,"  and  when  Jim  asked,  "What  the  divil  is 
a  layder? "  he  replied,  "When  folks  get  to  do  in  pubHc  what 
common  folks  does  in  private,  they're  layders."  Is  it  not 
true  that  this  is  the  way  we  fashion  our  lives? 

With  the  progress  of  civilization  comes  steady  increase 
in  the  facilities  for  living.  Convenience  and  comfort  are 
generally  increased.  Resources  and  materials  for  further- 
ing activities  and  happiness  are  enormously  developed. 
The  result  is  that,  for  the  people  who  have  access  to  these 
resources,  the  line  between  necessities  and  desires  is  lost 
and  we  find  aquired  a  myriad  of  wants  which,  for  the 
most  part,  are  confused  with  needs. 

Avoiding  all  discussion  of  these  as  an  economic  ques- 
tion, my  theme  directs  me  merely  to  a  discussion  of  the  good 
or  bad  in  this  in  relation  to  physical  well-being.  One  can 
not  go  into  this  in  detail,  but  it  blocks  itself  out  in  thought 
clearly  enough.  Given  the  ability  to  procure  unlimited 
food,  what  determines  the  amount  and  character  of  the 
food  that  we  eat?  When  all  things  are  available,  w^hat 
guides  us  in  our  doings?  When  we  have  a  distinct  choice 
as  to  the  amount  of  physical  labor  ^ve  shall  perform,  upon 
what  do  we  decide  the  question  ?  So  with  our  sleep,  so  with 
tobacco  or  alcohol  or  narcotics,  the  question  is  pertinent, 
Upon  what  ground  do  we  adopt  and  pursue  our  daily  habits  ? 


3o6  HENRY     BAIRD     FAVILL 

I  venture  the  assertion  that  for  the  most  part  the  grounds 
are  two,  fashion  and  self-indulgence. 

Although  I  am  predicating  unlimited  access  to  things, 
this  indictment  is  by  no  means  confined  to  persons  of  wealth. 
Almost  everybody  above  a  certain  level  has  sufficient  choice 
in  this  matter  to  participate  in  all  abuses.  Does  any  one  of 
us  underrate  the  difficulty  of  selecting  a  path  divergent  from 
the  common,  and  more  or  less  counter  to  it?  Stop  and 
think.  Are  not  all  our  personal  and  domestic  habits  fash- 
ioned upon  a  conventional  method  which  is  modified  from 
time  to  time  by  influences  which  are  arbitrary  or  accidental? 

Without  attempting  to  dispute  that  the  gradual  work- 
ing out  of  a  method  of  living  by  a  people  in  the  process  of 
civilization  has  a  certain  a  priori  sanction  as  a  phase  of 
evolution,  I  assert  that,  in  matters  of  health,  this  is  especial- 
ly open  to  scrutiny  and  review,  and  so  far  as  we  fail  to  act 
individually,  we  fail  to  exercise  such  discrimination. 

Every  practicing  physician  knows  the  difficulty  of  in- 
augurating new  habits  in  those  whom  he  has  occasion  to 
advise.  The  reasons  for  this  are  many.  Sometimes  it  is 
embarassing  to  be  different  from  other  people.  Sometimes 
it  is  disagreeable  to  do  a  hard  thing,  when  an  easy  thing  is 
at  hand.  Sometimes  it  is  a  bother.  But  the  real  difficulty 
lies  in  the  attitude  of  the  individual  toward  the  project. 

He  goes  to  a  physician  looking  for  dictation  rather 
than  light.  He  accepts  whatever  he  may  get  on  a  basis 
of  obedience  rather  than  instruction.  In  short,  he  is 
seeking  a  compromise  on  the  score  of  his  comfort,  rather 
than  knowledge  to  fortify  him  in  a  real  desire  to  maintain 
an  ideal. 

What  the  physician  encounters  is  typical  of  the  usual 
attitude.  It  takes  self-discipline  to  be  abstemious.  It 
takes  self-respect  to  be  individual.  It  takes  self-possession 
to  be  undisturbed  in  the  confusion  of  social  opinion  and 
prejudice.  For  that  reason,  I  say  health  cultivation  is  a 
function  of  character. 


M  K  D  1  (    I  N  K      A  N  I)      I'  C  I',  I.  I  (       II  I',  A  I.  I   II  307 

Granted  all  these  attributes  of  an  int(,'llij^ent  individual, 
there  still  remains  a  necessity  for  a  true  conception.  There 
is  basis  for  morality  in  physiolojo''  ^^  there  is  in  theology. 
It  is  as  false  in  physics  as  it  is  in  ethics  to  determine  con- 
duct on  the  basis  of  penalty.  Let  us  fix  this  distinction 
clearly.  We  live  correctly  not  to  avoid  disease,  but  to 
attain  our  birthrij^ht.  1'he  princii)le  is  constructive;  the 
obligation  is  supreme. 

The  point  is  to  obtain  the  best  individual  development 
that  is  possible.  The  process  must  be  through  demonstra- 
tion and  interpretation.  Is  it  not  perfectly  obvious  that 
this  can  only  commence  in  childhood,  which  is  tantamount 
to  saying  that  it  must  be  accomplished  in  the  school? 

I  protest  earnestly  against  any  philosophy  which  tends 
to  obscure  this  obligation.  Let  us  remember  that  to  be 
charged,  to  the  degree  that  teachers  are  charged,  with  the 
welfare  of  humanity  is  an  awe-inspiring  responsibility. 
Decisions  which  are  reached  must  not  be  matters  of  taste 
or  fancy  or  idiosyncrasy.     They  must  be  right. 

I  admit  freely  that  to  establish  this  conception  of  phys- 
ical well-being  generally  is  not  only  enormous  in  its  magni- 
tude, but  a  reversal  in  human  philosoph^^  So  much  deeper, 
then,  the  reason  for  grappling  with  it,  so  much  more  satis- 
factory as  an  opportunity  for  real  achievement. 

Logically,  the  first  step  is  so  to  determine  the  sanitary- 
conditions  of  our  custody  of  children  as  to  promote  and  in- 
sure their  well-being. 

Actually,  this  desirable  position  is  far  off.  A  campaign 
of  education  of  the  public  —  la}^  pedagogic,  and  official  — 
will  have  to  precede  any  satisfactory'  advance.  Let  us  re- 
member that  the  child  of  to-day  is  the  public  and  official  of 
to-moriow,  and  take  heart.  Meanwhile,  there  lies  within 
the  control  of  school  teachers  a  powerful  influence.  The 
factors  in  this  are  two:  the  curriculum,  and  cooperation 
with  the  authority  of  the  State. 

The  public  health  function  of  the  State  is  nowhere  more 


3o8  HENRY     BAIRD     FAVILL 

potent  than  in  its  relation  to  the  school.  In  the  existing 
state  of  society  there  is  a  tendency  to  clash  between  school 
authorities  and  school  population.  There  is  a  territory  of 
intimate  mutual  interest  lying  between  the  school  and  the 
home,  in  which  neither  has  indisputable  authority.  It  is 
right  and  necessary  that  the  State  occupy  this  field  and 
determine  the  law  that  shall  govern  these  reciprocal  rela- 
tions. 

For  the  present  it  is  important  that  there  be  public 
supervision  of  such  a  character  as  to  give  continuity  to  the 
efforts  that  are  initiated  in  each  territory  as  they  spread 
into  the  other.  Hence,  for  example,  the  importance  of  re- 
inforcing school  inspection  by  visiting  nurses  or  of  counter- 
acting parental  laxness  by  official  inspection.  We  shall  see 
that  the  State  will  broaden  its  interest  and  responsibility  in 
these  matters  until  protection  is  realized.  Necessar}^  as 
this  is  on  the  basis  of  protection,  if  it  is  well  carried  on 
it  becomes  of  important  educative  value  and  will  enhance 
the  public  appreciation  of  intelligence  in  living. 

The  school  teacher  can  perfect  or  ruin  this  attempt  ac- 
cording to  his  efforts  in  cooperation.  Though  it  falls  far 
short  of  a  solution  of  our  problem,  it  is  obviously  the  first 
step  and  is  imperative. 

As  the  idea  of  the  social  character  of  the  school  grows, 
opportunity  to  touch  effectively  the  real  life  of  children  will 
broaden.  When  the  day  comes  that  the  child  seeks  his 
light  in  the  school  as  naturally  as  he  seeks  his  orders,  the 
school  will  have  come  into  its  own. 

At  present,  the  great  limitation  upon  the  school  is  in 
lack  of  facilities.  Tradition  and  economy  are  hard  masters. 
Overcrowding,  bad  air,  poor  light,  imperfect  seats,  and  in- 
sufficient teachers  are  charged  to  lack  of  money.  Rigid 
ideas  as  to  confining  children  hour  after  hour  to  their  desks 
like  cattle  in  their  stanchions,  prolonged  pursuit  of  mental 
tasks,  unrelated  to  interest  and  unassisted  by  inspiration, 
are  chargeable  to  tradition. 


MEDICINE     AND     J'  I,  li  L  1  L      III:  A  LI  J I  309 

Lack  of  money  is  not  really  lack  of  money.  It  is  lack 
of  willingness  to  divert  money  sufficiently  into  its  j^roper 
channel.     It  is  really  lack  of  conception. 

Tradition  is  not  insuperable.  It  is  to  a  very  large  ex- 
tent an  obstacle,  because  teachers  are  insufficiently  repre- 
sented in  the  councils  which  determine  teaching  methods. 

The  interest  of  teachers  can  be  stifled  by  sufficient  non- 
participation  in  the  intellectual  activities  involved  in  the 
school  management.  No  part  of  the  curriculum  is  more  vul- 
nerable to  stupidity  than  that  which  concerns  the  physical 
well-being  of  children.  No  part  is  more  in  need  of  initiative 
on  the  part  of  the  teacher.  We  are  bound  to  do  this  work 
better. 

I  repeat,  the  process  must  be  through  demonstration 
and  interpretation.  Can  we  hope  for  any  impression  upon 
the  developing  child  unless  we  furnish  that  child  obvious, 
hygienic  methods  during  his  school  life?  Can  we  hope  to 
derive  full  benefit  from  the  most  perfect  hygienic  conditions 
unless  the  significance  of  these  conditions  is  interpreted? 

The  child  must  grow  its  conception,  and  there  must  be 
concurrent  and  incessant  association  between  proper  con- 
ditions and  appreciation  of  their  value. 

For  our  possibilities  of  demonstration,  we  must  plead 
with  the  public  for  generous  and  enlightened  disposition  of 
funds;  for  our  interpretation,  we  depend  solely  upon  peda- 
gogic force. 

Let  us  ask  this  question :  To  what  extent  is  the  average 
school  curriculum  based  upon  or  related  to  the  physical 
needs  of  the  children?  I  do  not  mean  to  imply  in  this 
question  that  it  is  not  to  a  considerable  extent  so  related. 
Is  it,  however,  fundamentally  determined  by  those  needs? 
Ought  it  not  to  be? 

Let  us  approach  the  question  from  another  angle: 
What  is  the  attitude  of  the  school  authorities  in  the  most 
enlightened  educational  circles  with  reference  to  children 
who  are  physically  defective? 


3IO  HENRY     BAIRD     FA  V  ILL 

Is  it  not  true  that  an  effort  is  being  made,  here  and 
there,  to  find  a  solution  of  the  problem  by  a  radical  depar- 
ture in  system?  I  call  your  attention,  for  example,  to  the 
celebrated  school  at  Charlottenberg,  created  for  the  special 
treatment  of  sick  and  debilitated  children.  The  enterprise 
was  instituted  to  meet  serious  conditions.  If  such  children 
were  treated  in  a  sanitarium,  they  were  not  educated.  If 
they  were  educated  in  schools,  they  declined  and  died,  or 
became  hopeless  invalids.  The  combination  of  sanitarium 
method  and  school  was  found  largely  to  solve  the  problem. 
A  very  great  percentage  is  restored  to  health.  Practically 
all  reach  normal  educational  standards.  Nine-tenths  of 
them  are  able  to  resume  school  work. 

In  the  light  of  this  illustration,  is  there  any  reason  why 
a  school  curriculum  based  upon  judicious  hygiene  should 
not  be  the  prevailing  type,  instead  of  the  exceptional  type? 
This  is  a  repetition  of  experience.  Methods  which  are 
found  to  be  necessary  and  effective  to  cure  established 
disease  give  the  key  to  proper  hygiene  for  those  who  are 
still  normal.     You  have  seen  this  illustrated  familiarly. 

Since  the  world  has  discovered  the  proper  treatment  for 
tuberculosis,  the  natures  and  habits  of  innumerable  people 
who  are  well  have  been  molded  to  correspond  to  the  prin- 
ciples involved. 

I  do  not  suggest  that  the  average  school  be  brought  to 
the  extreme  type  of  the  special  school  for  the  defectives. 
What  I  wish  to  emphasize  is  that  there  is  neither  logic  nor 
justice  in  recognizing  hygienic  principles  only  for  those  who 
are  ill.  Wisdom  dictates  that  the  principles  of  hygiene  be 
determined  broadly  and  practicably  and  that  they  be  ac- 
cepted as  the  initial  point  in  the  determination  of  a  school 
curriculum. 

This  is  not  the  point  at  which  to  attempt  to  discuss  the 
detail  of  such  a  program.  The  thing  to  establish  is  acqui- 
escence in  the  proposition  that  sound  hygiene  is  funda- 
mental to  any  school  curriculum. 


M  !<;  I)  I  (■  I  N  10      AND      IM;  |{  I-  I  (       III.  A  1,1   II  ^u 

There  arc  certain  defects,  however,  which  it  is  worth 
while  to  touch  upon.  IVTha])s  chief  of  these  is  the  question 
of  fresh  air.  No  problem  of  the  school-room  is  more  dififi- 
cult  to  solve  under  existing  conditions.  None  is  more 
crucial.  I  cannot  take  your  time  to  i^o  into  that  in  detail. 
I  must  ask  you  to  fill  in  the  things  I  have  left  unsaid;  but 
this  I  wish  to  say:  the  child  should  be  educated  to  an 
abundance  of  fresh,  cool  air,  fresher  than  it  is  accustomed 
to,  cooler  than  is  perhaps  comfortable  at  first.  If  involving 
a  process  of  hardening,  why  not? 

Please  believe  that  I  realize  the  difficulties  in  this  sug- 
gestion. Obstruction,  complaint,  and  criticism  are  inevi- 
table. School  architects  and  school  authorities  have  not 
crossed  the  threshold  of  this  proposition.  No  matter  what 
the  difficulties,  it  is  an  absolute  necessity  that  this  question 
be  met.  It  will  pay  many  fold,  not  only  in  health,  but  in 
educational  results. 

Let  us  take  another  question  —  that  of  physical  activi- 
ties. I  wish  to  take  unequivocally  the  position  that  com- 
petitive athletics,  under  the  conditions  prevailing  at  present, 
are  a  serious  bar  to  general  physical  development,  whether 
in  themselves  objectionable  depending  upon  circumstances. 
At  present  they  usurp  and  monopolize  the  field  of  physical 
development  to  the  extent  of  limiting  participation  to  those 
who  have  signal  ability.  They  concentrate  interest  upon 
competitive  success  and  not  at  all  upon  intrinsic  physical 
superiority. 

From  the  primary  grade  to  the  end  of  the  college 
course  this  criticism  is  progressively  just.  Until  athletics 
(so-called)  can  be  put  in  their  proper  position  of  exceptional 
demonstration  functions,  they  will  continue  to  be  a  seriously 
pernicious  factor  in  this  educational  field. 

Every  child  should  be  trained  physically  to  its  best 
point,  and  no  influence  which  stifles  interest  and  cripples 
effort  by  establishing  impossible  standards  can  be  permitted 
to  dominate  indefinitelv. 


312  HENRY     BAIRD     FAVILL 

Children  can  not  be  forced  into  a  process  of  physical 
development,  which  shall  be  continuous,  without  interest. 
So  far  as  I. can  see,  this  interest  can  only  be  supplied  by 
evolving  gradually  and  consistently  an  ideal  of  physical 
perfection  to  which  each  shall  adhere  as  tenaciously  as  to 
any  standard  in  life. 

Let  individual  achievement  displace  the  desire  for  con- 
spicuous success.  Let  emulation  take  the  place  of  dis- 
heartened envy.  Let  a  high  standard  of  school  superiority 
displace  the  feverish  eagerness  for  the  glory  of  a  winning 
team.  Then  may  we  hope  for  general  growth  of  an  ideal 
which  shall  guide  our  physical  lives. 

In  conclusion,  let  us  realize  that  mental,  moral,  and 
physical  poise  go  together.  Disciplinary  factors,  external 
and  internal,  involved  in  self-control  are  of  incalculable 
value  in  the  growth  of  character. 

Is  there  any  prospect  of  realizing  our  legitimate  hope 
for  the  race  struggling  with  the  incubus  of  civilization, 
except  in  the  apprehension  by  teachers  of  the  importance  of 
this  matter?  Is  there  any  other  class  of  society  which  can 
undertake  to  develop  and  mobilize  the  conviction  necessary 
to  accomplish  this  regeneration? 


MEDKINIC     A  N  IJ      I'  C  I',  M  C      ilJvAL'III  313 


Delivered,  Chicajiio  Medieul  Society,  January  2(>,  i^io. 
Printed,  Chicago  Medical  Recorder,  February,  1910. 

THE  RESPONvSIBILITY  OF  THE  MEDICAL 
PROFESSION 

THE  title  of  this  talk  rather  suggests,  as  I  look  at  it  now, 
a  sermon  or  something  in  the  nature  of  a  homily  as  to 
what  the  medical  profession  ought  to  do.  I  assure 
you  that  it  is  not  my  intention  so  much  to  deliver  myself 
of  fixed  opinions  as  to  the  responsibility  of  the  medical  pro- 
fession, as  it  is  to  open  a  series  of  questions  which  have  come 
to  my  own  mind  recently  in  the  observation  of  medical 
affairs. 

I  think  you  will  agree  with  me  that,  outside  of  medical 
ranks,  the  forces  in  society,  which  are  at  present  dealing 
most  earnestly  and  most  intelligently  with  questions  of 
health,  are  profoundly  impressed  with  the  problems  pre- 
sented by  the  general  health  of  the  community,  the  health 
of  the  public.  All  organizations,  which  are  working  from  a 
philanthropic  or  sociological  standpoint,  are  convinced  that 
there  is  no  question  before  the  minds  of  the  people  of  the 
world  to-day  more  important  than  the  question  of  health. 
This  is  not  from  a  standpoint  of  philanthropy  particularly, 
but  from  the  standpoint  of  the  State,  from  the  standpoint 
of  conservation  of  the  efficiently  active  indispensable  factors 
in  statehood,  the  preservation  of  the  health,  vitality,  and 
productive  capacity  on  the  one  hand,  and  the  prevention  of 
dependence  and  helplessness  on  the  other. 

This  matter  has  become  so  crs^stallized  in  the  minds  of 
the  intelligent  leaders  of  sociologic  thought  that  all  of  the 
operations  of  public  officials,  and  of  State  interests  in  this 
matter,  are  focusing  rapidly  in  a  given  direction.  Of  all 
the  things  which  these  forces  in  society  are  endeavoring  to 
encompass,  nothing  is  more  important  than  the  subject 
of  industrial   disease.     It   is  rather  trite   to  sav   that   the 


314  HENRY     BAIRD     FA  V  ILL 

mortality  and  disability  of  a  single  year,  unnecessary  and 
preventable,  is  greater  than  that  of  any  war  that  ever  oc- 
curred, and  \-et  this  is  the  case  year  after  year,  and  the  forces 
of  public  opinion  and  the  machinery  of  public  interest  are 
rapidly  coming  to  recognize  that  something  has  to  be  done 
to  eradicate  this  wanton,  unnecessary  destruction  of  life, 
efficiency,  and  independence. 

I  want  to  call  your  attention  briefly  to  the  great  differ- 
ence there  is,  so  far  as  this  investigation  and  effort  is  con- 
cerned, between  m.ortality  and  morbidity.  We  have,  or  can 
have,  very  reasonably  accurate  statistics  on  mortality;  but 
we  have  in  this  country  practically  no  statistics,  no  data 
upon  morbidity.  We  know  people  die  and  when  and  of 
what  they  die,  but  have  practically  no  knowledge  as  to  how 
they  got  sick,  when  they  got  sick,  or  the  relationship  of  their 
conditions  of  life,  their  work  or  habitation  or  whatever  it 
may  be,  to  their  sickness. 

Now  it  is  with  regard  to  this  phase  of  the  matter  that  I 
particularly  wish  to  call  attention.  Unless  we  can  find  some 
way  of  determining  what  the  morbidity  factor  is,  what 
amount  of  sickness  is,  where  it  arose,  what  its  relation  was 
to  the  conditions  under  which  it  arose,  we  are  getting  no- 
where in  our  treatment  of  this  great  question  of  industrial 
diseases. 

The  great  question  is,  how  are  we  going  to  determine 
these  facts  as  to  morbidity  ?  How  are  we  going  to  find  out 
who  is  sick,  how  he  or  she  got  sick,  and  what  the  logical 
relationship  is  to  the  conditions  of  life  work  and  habitation  ? 
It  is  just  at  that  point  that  it  seems  to  me  that  the  respon- 
sibility of  the  medical  profession  is  vital.  AVho  knows  in  gen- 
eral the  question  of  sickness?  The  doctors.  Who  knows 
the  conditions  of  the  sickness  and  its  incipient  stages?  The 
doctors.  Who  knows  the  probable  relationship  to  condi- 
tions of  life,  habitation,  recources,  wages,  hours  at  work, 
industrial  conditions  generally?  The  doctors.  Who  else 
knows  it  ?    Nobody  so  directly.    The  charitable  organizations 


M  i<;  I)  I  c  I  N  10    AND    I' II  in.  I  r    iii'iAi.'fn       315 

know  it.  finally  in  llic  staj^e  of  n.'lief,  hut  the  mcflical  jjro- 
fession,  taken  in  detail,  knows  it  and  knows  all  about  it, 
at  the  l)e^inninj4  and    from   the  bej^inning  on. 

This  constitutes  in  my  judgment  a  reason  why  the 
medical  profession  sh(Mi]d  eharge  itself  with  the  responsi- 
bility for  gathering  and  collating  and  preserving,  and  where 
necessary  handing  on  to  proper  f)rganizations  the  facts 
of  morbidity  in  the  people  with  whom  it  is  in  contact. 
Of  course,  I  am  not  here  to  suggest  that  any  one  doctor, 
by  keeping  any  one  list  of  cases  and  reporting  them  in  any 
way  to  anybody,  could  accomplish  much.  I  am  talking 
now  of  the  duty  of  the  medical  profession  at  large,  the  duty 
that  seems  to  me  perfectly  plain  because  it  is  the  only 
factor  of  any  value  or  ef^ciency  with  reference  to  the 
question  of  morbidity.  Because  it  is  the  sole  factor  in  the 
situation  which  is  capable  of  rendering  efficient  service, 
I  say  it  is  sufficient  reason  why  the  medical  profession 
should  charge  itself  with  the  responsibility. 

And  yet  the  question  may  be  asked,  as  it  is  asked  not 
only  with  regard  to  this  question  but  with  regard  to  in- 
numerable others:  "Why  should  we  charge  ourselves  w4th 
this?  Are  we  not  over-burdened  with  work  already  that 
we  are  not  paid  for?  Do  we  not  render  hard,  unselfish 
service  to  the  utmost  of  our  strength  and  ability?  Are  we 
not  already  doing  that  more  than  any  other  element  in  the 
community?  And  I  think  on  the  whole  the  answ^er  is, 
"Yes,  we  are."  But  yet  the  question  remains:  "What 
is  our  obligation  in  the  matter?" 

I  think,  however,  that  there  is  a  phase  of  this  matter, 
and  this  I  speak  of  with  a  great  deal  of  hesitation  because 
it  is  not  clear,  which  is  of  great  importance.  I  speak  wnth 
hesitation  because  I  am  not  quite  sure  of  what  I  want  to 
say.  We  all  of  us  know^  and  there  is  not  a  physician  with- 
in reach  of  my  voice  who  does  not  know,  without  being 
able  exactly  to  explain,  that  the  whole  question  of  the 
practice  of  medicine  is  undergoing  a  change;  that  the  w^hole 


3i6  HENRY     BAIRD     FA  V  ILL 

future  of  medicine,  as  judged  by  the  present  practice  of 
medicine,  is  undergoing  a  change.  There  is  no  one  here 
who  does  not  recognize  that  there  is  not  as  much  practice 
as  there  used  to  be,  and  that  it  is  not  accidental,  but  that 
it  is  a  phase  of  some  evolutionary  process.  Now  without 
undertaking  to  explain  that,  or  going  into  any  detail,  I 
want  to  call  your  attention  to  the  fact  that  the  whole 
medical  profession  is  in  a  state  of  transition.  The  interests 
of  the  large  masses  of  people  are  the  interests  of  the  medical 
profession.  The  practice  of  medicine  is  not  a  mere  practice 
amongst  the  aristocrats,  the  wealthy,  or  even  the  well- 
to-do.  The  great  facts  of  the  practice  of  medicine  are 
the  facts  of  the  masses  of  people.  You  know  that  the 
interests  of  the  masses  of  people  are  becoming  more  and 
more  recognized  as  the  legitimate  interests  of  the  State,  the 
legitimate  interests  of  public  officials  in  one  way  or  another, 
for  reasons  which  are  perfectly  obvious.  More  and  more 
we  are  coming  to  see  the  trend  of  medical  affairs  as  applied 
to  the  mass  of  people,  drawing  ever  toward  officialism 
or  some  modification  of  officialism.  Of  this  I  have  no 
considerable  doubt.  I  think  everybody's  observation  must 
bear  this  out.  Personally  I  can  not  look  with  any  great 
eagerness  towards  ultra-officialism  in  the  administration  of 
medical  affairs.  I  believe  that  the  modification  of  officialism 
would  be  better,  but  there  can  be  only  such  modification 
as  is  incident  to  and  consequent  upon  an  awakening  sense 
on  the  part  of  the  medical  profession,  of  its  importance  in 
pubhc  health  affairs,  and  consequently  its  obhgation  in  pub- 
lic health  affairs. 

In  my  opinion,  the  only  way  that  the  medical  prof ession 
is  going  to  save  itself  from  the  smothering  influence  of  State 
intervention,  State  dominance,  if  you  like,  in  the  broad  and 
deep  affairs  of  medical  practice,  as  related  to  public  health, 
is  by  seeing  its  own  importance,  its  obligation,  and  hence 
by  its  effort  to  get  into  such  a  relationship  of  indispensable 
value  to  the  whole  subject  as  to  make  it  the  necessary  and 


M  E  D  I  C  I  N  K      AND.    IMT  H  F.  I  C      FI  K  A  I.  T  FF  317 

logical  agent  tlirouj^h  which  the  State  shall  operate  in  the 
maintenance  and  furtherance  of  its  public  affairs.  It  is 
my  conviction  that  the  medical  profession  as  a  body  should 
undertake  and  set  for  itself  tasks  related  to  public  health, 
in  the  nature  of  conservation  of  public  health,  and  of  coop- 
eration with  State  forces.  Such  tasks  will  clearly  demon- 
strate, first,  the  interest  of  the  profession ;  second,  the  capac- 
ity of  the  profession  to  deal  with  them,  which  is  by  no  means 
recognized  now;  and  third,  the  fact  that  the  profession  can- 
not be  dispensed  with  in  this  new  phase  of  its  vocation. 
For  all  of  these  reasons  which  I  have  hastily  sketched, 
it  seems  to  me  that  the  responsibility  of  the  medical  profes- 
sion to  the  public  as  a  moral  issue,  and  as  a  practical  issue, 
is  beyond  peradventure.  And  yet  I  set  this  forth  as  a  series 
of  very  deep  convictions  and  as  an  expression  of  wonder 
that  I  have  as  to  whether  these  things  are  not  ripe  for  action. 


3iS  HENRY     BAIRD     FA  V  ILL 


Date  and  occasion  of  writing  unknown. 

THE  ATTITUDE  OF  THE  MEDICAL  PROFESSION 
REGARDING   MEDICAL   PRACTICE   LAWS 

THE  majority  by  far  of  the  members  of  the  medical 
profession  have  no  concern  and  no  conscious  interest 
in  medical  practice  acts.  A  small  minority  have  a 
clamorous  desire  for  restriction  as  a  measure  of  self-protec- 
tion. A  very  small  number  are  engaged  in  a  process  of 
incubating  an  idea  conceived  in  justice  and  dedicated  to 
public  interest. 

The  difficulty  in  making  obvious  this  foundation  and  the 
aggressiveness  of  private  interests  have  thus  far  operated 
as  obstacles  to  satisfactory  legislation  in  most  of  the  fields 
so  far  attacked.  Defect  in  conception  as  to  what  a  practice 
act  should  be,  has  been  and  is  the  greatest  bar  to  progress. 
We  may  safely  start  with  the  generalization  that  there  is 
no  conflict  between  professional  interest  and  public  interest. 
There  can  be  no  such  clash,  and,  at  any  point  that  such 
apparent  conflict  occurs,  the  interpretation  of  various  rights 
and  privileges  involved  must  be  reviewed. 

It  is  only  necessary,  therefore,  to  analyze  the  needs  of 
the  public  in  order  to  discover  the  elements  essential  in 
restrictive  or  corrective  legislation,  employing  the  interests 
of  the  medical  profession  only  as  a  sidelight  in  which  to 
criticise  conceptions  of  public  welfare.  Although  this  prop- 
osition departs  from  much  of  the  prevailing  expression  of 
opinion  upon  this  matter,  I  believe  that  it  is  reasonable 
to  predict  that  the  medical  profession  will  accept  the 
premises. 

Physicians  are  not  selfish  or  narrow  in  mind  as  a  class. 
In  practice,  local  conditions  and  peculiar  circumstances 
introduce  difficulty  in  professional  relations,  but  at  bottom 
the  ethical  solution  of  a  problem  is  acceptable  to  them. 


M  K  1)  I  (•  I  N  K      AND      I'  C  15  F.  I  C      li  I".  A  I.  T  Ff  319 

On  the  side  of  l,li(])iil)lir,  however,  difficulties  are  more  com- 
plex. We  are  looked  upon  with  suspicion  in  our  efforts  at 
legislation.  It  is  human  to  question  with  some  skepticism 
legislation  urged  by  a  class  looking  to  the  regulation  and 
perhaps  exclusion  of  a  part  of  a  class.  This  must  be  met 
and  overcome  in  the  course  of  this  agitation.  It  can  not  be 
avoided.  No  one  is  as  well  qualified  as  the  physician  to 
indicate  the  public  need  in  its  medical  relations.  The  bur- 
den of  proof,  however,  as  to  his  wisdom  and  altruism,  is  not 
small  and  his  sagacity  must  be  his  stronghold.  Recognizing 
these  facts,  the  organizers  of  this  movement  are  reaching 
freely  into  the  community  and  asking  cooperation  with 
agencies  which  have  standing  and  authority  in  legal  and 
sociologic  construction. 

The  first  step,  beyond  question,  is  education  of  our- 
selves and  of  our  cooperating  colleagues  in  the  other  profes- 
sions. With  a  well  defined  idea  held  by  a  coherent,  aggres- 
sive body  of  public  spirited  men,  some  solution  that  is  fair 
and  effective  will  not  be  far  oft'.  Have  we  as  yet  formu- 
lated that  idea?  Let  us  see.  Public  health  is  the  para- 
mount issue  in  public  affairs.  How  generally  is  this  recog- 
nized ?  Very  imperfectly,  yet  the  growth  of  that  belief  in  a 
few  years  is  clearly  an  index  of  world  wide  progress  toward 
that  conclusion.  As  health  is  for  the  individual  by  far  the 
most  important  consideration  in  life,  so  for  the  State  is  it 
the  most  vital  economic  problem  conceivable. 

The  entire  territory  involved  in  this  public  w^arfare, 
covering  sanitary,  hygienic,  and  individual  medical  ques- 
tions, is  within  the  necessary  purview-  of  medical  science. 

Broader  principles  and  possibilities  imply  deeper  obliga- 
tions, and  w^e  find  ourselves  facing  enormous  tasks.  Has 
the  State  the  right  to  direct  the  forces  necessary  to  effective 
application  of  scientific  health  measures  ?  Beyond  question, 
yes.  Why  and  how,  and  \^4th  what  limitations,  you  have 
heard  clearly  discussed  to-day.  The  line  of  definition  be- 
tween public  health  functions  and  private  practice  becomes 


320  HENRY     BAIRD     FAVILL 

rapidly  more  obscure.  These  territories  overlap  and  coin- 
cide to  a  degree  that  makes  any  distinction  temporary  and 
provisional,  and  perhaps  valueless  as  a  feature  of  legal 
action.  The  health  of  the  people  is  the  only  logical  con- 
sideration and  all  its  aspects  are  legitimate  objects  of 
attention. 

Assuming  that  the  State  will  establish  its  authority  in 
matters  of  public  health,  the  interesting  point  for  us  is  the 
relation  between  public  health  and  individual  health.  At 
what  point  does  the  public  aspect  of  the  question  disappear 
in  private  right?  Here  is  the  battle  ground.  On  the  one 
side  are  alligned  private  interests,  commercialism,  corrup- 
tion, various  conceptions  of  individual  liberty,  and  all 
varieties  of  economic  non-interference  theories.  Upon  the 
other,  may  be  found  clear  thinking,  determined,  practical 
guardians  of  public  weal  upon  the  platform  of  moral  obli- 
gation. 

What  are  the  obvious  needs  of  to-day?  First,  a  large 
body  of  trained  health  officers.  Second,  an  organized  body 
of  physicians  for  the  equipment  of  institutions  of  relief. 
Third,  cooperation  in  the  application  of  resources  of  medical 
science.  Fourth,  maximum  competency  in  the  mass  of 
physicians  who  treat  people  of  limited  means.  Fifth,  some 
standardization  of  medical  practice  whereby  it  may  be 
apparent  to  the  public  which  physicians  are  qualified  and 
which  not  qualified  under  the  terms  of  such  standards. 

It  is  obvious  under  this  proposition  that  medical  stand- 
ards in  education  must  continue  to  advance.  To  those  fam- 
iliar with  all  the  facts,  it  is  a  matter  of  regret,  and  to  those 
familiar  with  only  part  of  the  facts,  incomprehensible,  that 
medical  education  in  this  country  has  not  adopted  this  ques- 
tion of  prime  importance,  the  education  of  health  officers. 
This  is  not  the  time  to  discuss  that  subject,  but  I  can  not 
refrain  from  stating  that  the  main  reason  why  this  is  so  is 
an  astonishing  lack  of  comprehension,  on  the  part  of  medical 
educators,  of  the  significance  and  importance  of  public  health 


MEDICINE      AND       I'  I'  15  I,  I  f       III'ALTD        321 

administration.  ICitluT  schools  must  accept  their  legitimate 
burden,  or  the  vState  must  undertake  independent  educa- 
tional work. 

The  organization  of  a  dispensary  or  hospital  staff  upon  a 
basis  of  efficient  cooperation  is  clearly  a  medical  function, 
and  so  important  that,  if  it  is  not  done,  any  medical  practice 
act  will  be,  to  a  large  extent,  nullified.  Elevation  of  the 
rank  and  file  of  physicians  in  point  of  fundamental  educa- 
tion and  practical  efficiency  clearly  rests  with  the  medical 
profession,  and  yet  as  a  practical  feature  it  is  found  to  go 
only  pari  passu  with  public  demand. 

Public  demand  as  to  the  competency  of  medical  practi- 
tioners is  not  as  unequivocal  as  one  would  expect.  It  is  an 
interesting  psychological  question  why  the  first  reaction  of 
the  public  toward  medical  practice  acts  should  be  one  of 
opposition.  I  think  experience  rather  shows  this  to  be  true. 
In  making  this  assertion  one  must  qualify  by  saying  that 
only  a  part  of  the  public  is  thrown  into  such  opposition. 
Aside  from  the  selfish  and  pecuniary  interests  which  will 
always  furnish  a  fixed  opposition,  there  is  a  large  mass  in 
the  community  which  thinks  more  or  less  about  public  mat- 
ters. There  is  a  much  larger  mass  which  thinks  not  at  all 
and  is  tremendously  the  prey  of  bad  practice  and  intense- 
ly the  object  of  solicitude  on  the  part  of  the  government. 
But,  effective  opposition  comes  from  the  thinking  mass  of 
people  and  the  reason  for  it  is  comparatively  simple.  Medi- 
cal relations  are  essentially  personal,  intimate,  and  tempera- 
mental. The  more  intelligent  people  are,  the  more  this  is 
true.  There  is  an  instinctive  and  more  or  less  legitimate 
repugnance  on  the  part  of  most  people  to  having  to  be  even 
indirectly  dictated  to  in  such  relationships. 

The  most  effective  argument  against  all  efforts  at  legis- 
lation has  been  and  will  continue  to  be  an  assertion  of  the 
right  to  employ  for  one's  physician  whomever  one  chooses. 
Under  the  existing  conditions  of  society  this  is  sound, 
and  no  medical  practice  act  which  fails  to  recognize  this 
12 


322  HENRY     BAIRD     FAVILL 

fundamental  principle,  in  my  judgment,  can  be  effective. 

The  conclusion  from  this  proposition  is  obvious.  The 
State  through  legislation  can  only  effect  the  elements  of 
choice  by  some  form  of  definition  which  shall  make  possible 
at  once  fair,  safe,  and  intelligent  choosing.  The  obvious 
conflict  that  there  is  between  public  interest  and  individual 
right  at  certain  points  is  quite  another  question.  Those 
are  matters  of  construction  as  to  police  power  which  lie 
quite  outside  the  domain  of  medical  practice  acts.  The 
proposition  becomes  simple  to  state  and  difficult  to  answer: 

Shall  the  State  under  its  forms  of  selection  permit  prac- 
tice, or  shall  it  simply  illuminate  practice? 

Shall  the  State  designate  who  may  practice,  or  shall  it 
define  the  qualifications  of  those  who  are  in  practice  ? 

Shall  it  license  or  shall  it  accredit? 

These  are  the  two  lines  of  procedure  essentially  different 
in  principle  and  operation. 

The  choice  between  these  alternatives  relates  necessarily 
to  the  probable  effect  upon  public  interest  and  particularly 
the  items  which  I  have  before  mentioned,  namely,  health 
officials,  dispensary  organization,  professional  cooperation, 
general  improvement  in  medical  education,  and  the  fixing 
of  a  standard  which  shall,  through  education,  come  to  be 
recognized  as  a  safe  guide  to  the  public  in  the  selection  of 
medical  advisers. 

Concerning  the  first  three,  the  medical  schools  and  the 
medical  profession  will  be  able  effectively  to  determine  a 
proper  standard  and  process.  These  are  essentially  socio- 
logic  questions,  but  to  be  worked  out  probably  by  a  com- 
bination between  social  service  and  medical  officials  to  a 
satisfactory  issue.  As  to  medical  education  and  a  public 
standard  the  case  is  different. 

There  is  no  doubt  that  the  present  plan  generally  opera- 
tive of  licensing  physicians  upon  State  examination  has  had 
a  marked  influence  in  raising  the  standard  of  requirements 
in  medical  instruction,  generally,  in  this  country.     It  has 


M  i<:  I)  I  (•  I  N  ic    AN  I)    r  i;  li  l  i  (     ii  i-:  a  f.  t  ii       323 

had  l)y  no  means  as  much  infUicnc-e  as  it  was  hoped  nor  as 
much  as  is  usually  ascribed  to  it. 

The  improvement  in  standards  and  requirements  in 
medical  schools  in  recent  years  has  been  particularly  in  those 
schools  which  in  the  nature  of  things  would  have  improved 
under  growing  conceptions  and  higher  ideals.  All  of  the 
leading  colleges,  as  a  mere  matter  of  evolution  of  medical 
thought,  would  have  reached  their  present  status  without 
State  requirements.  Certain  of  the  colleges  of  less  standing 
doubtless  have  been  influenced  by  the  necessity  of  putting 
their  graduates  into  a  safe  position  respecting  vState  exami- 
nation, but  the  mass  of  inferior  and  objectionable  institu- 
tions, which  are  grinding  out  graduates  by  one  process  or 
another,  whose  graduates  are  passing  State  examinations 
of  the  character  now  in  vogue  with  facility,  are  neither 
influenced  nor  embarrassed  by  the  present  system. 

This  would,  of  course,  not  be  true  if  State  examinations 
were  more  rational  and  real,  but  as  long  as  a  State  exami- 
nation is  of  such  a  character  that  it  can  be  passed  by  mere 
book  knowledge,  no  reflex  upon  college  curricula,  which 
are  essentially  spurious  and  a  pretense,  is  likely  to  occur. 
Nothing  can  be  more  vicious  than  an  examination  of  pure- 
ly formal  character  coupled  with  the  present  standard  of 
eligibility. 

To  declare  any  candidate  eligible  who  has  a  diploma 
from  a  "recognized"  medical  school,  to  recognize  medical 
schools  upon  the  basis  of  fictitious  presentation  and  fraudu- 
lent method,  and  then  to  complete  the  test  by  an  examina- 
tion which  any  man  w4th  a  good  memory  and  no  medical 
training  can  easily  pass,  is  not  only  futile  but  in  the  highest 
degree  iniquitous. 

In  order  to  correct  the  vices  of  such  a  system  there  must 
be  absolute  reform,  first  in  the  definition  of  "good  stand- 
ing" as  established  by  the  State  authority,  second,  in  the 
character  of  the  examinations  which  shall  be  held  to  de- 
termine the  qualification  of  the  candidate.     Under  present 


324  HENRY     BAIRD     FAVILL 

conditions  neither  of  these  reforms  can  come  to  pass  for  a 
great  while.  The  political  power  of  interested  factors  in  the 
problem  is  sufficient  to  keep  the  approved  list  of  colleges 
filled  with  fraudulent  and  inefficient  institutions.  The 
same  influences  operate  and  will  continue  to  operate  in  the 
constitution  of  examining  boards,  with  the  result  that  such 
boards,  with  the  best  of  intentions,  if  that  were  conceivable, 
will  be  utterly  incompetent  to  conduct  proper  examinations. 

Personally,  I  see  no  hope  in  the  immediate  future  for  any 
real  transformation  in  type  or  in  spirit  under  the  plan  of 
medical  license.  The  necessity  for  license  is  not  sufficiently 
obvious,  the  objections  to  it  are  too  cogent,  the  sources  of 
opposition  too  widespread,  and  methods  of  evasion  too  sim- 
ple, to  offer  considerable  promise  of  thoroughly  effective 
operation. 

Under  that  proposition  utterly  indefensible  standards  of 
recognition  as  to  colleges  will  certainly  prevail.  While  fail- 
ure to  pass  a  State  examination  involves  prohibiting  prac- 
tice, examinations  will  continue  to  be  misleading  and  in- 
effective. The  result  of  our  present  plan  of  operations  is, 
that  we  fully  accredit  and  foist  upon  the  public  an  army 
of  practitioners  utterly  incompetent,  with  the  absolute 
and  complete  stamp  of  approval  on  the  part  of  the  State. 
The  reflex  of  this  condition  upon  social  interests  is  bad. 
We  may  secure  from  the  ranks  of  physicians  so  endorsed  by 
the  State,  our  health  officers,  experts,  administrative  officers, 
to  say  nothing  of  the  rank  and  file  of  general  practitioners. 

For  the  most  part  these  objections  can  be  obviated  under 
another  plan.  If  it  were  possible  to  eliminate  from  con- 
sideration the  protests  of  individuals  on  the  plea  of  injustice, 
progress  could  be  made.  Fundamentally,  in  a  democracy  it 
is  more  ethical  to  lean  than  to  coerce,  and  the  plan  which 
appeals  to  me,  and  to  many  of  the  profession  who  are  con- 
cerned in  this  matter,  is  the  plan  of  accrediting  or  regis- 
tering upon  a  basis  of  high  scientific  standard.  This  plan 
has  the  merit  of  a  stronger  practical  usefulness  and  a  deeper 


M  IC  I)  [  (•  I  N  1';      AND      I'CIiLIC       HICAL'III  325 

ethical  basis.  It.  involves  simply  tlic  crcaUcMi  by  the  State 
of  a  trif)unal  which  sliall  earnestly  and  honestly  investi- 
gate and  pass  upc^n  the  cjualifieations  of  all  men  who  wish 
to  be  so  accredited. 

Why  is  not  this  plan  open  to  all  the  difficulties  and 
objections  of  the  plan  of  licensing!' 

First,  because  no  individual  rights  are  in  question  and 
the  factor  of  ])ublic  interest  stands  out  clearly  defined  and 
uncomplicated.  Second,  because  an  examination  based 
upon  that  principle  would  be  a  constant  and  increasing 
stimulus  to  medical  schools  toward  real  education  and  away 
from  formal  education.  Third,  it  would  be  comparatively 
easy  to  decree  that  public  health  administrators  of  all  degree 
could  come  only  from  such  an  accredited  list.  Fourth,  it 
is  hoped,  and  I  believe  with  reason,  that  the  public  would 
rapidly  be  educated  to  the  significance  of  such  registration 
or  the  lack  of  it. 

All  exercise  of  police  power  is  a  subject  for  apology  essen- 
tially related  to  an  exigency  and  theoretically  temporary 
and  provisional.  The  object  of  Hcensing  is  not  primarily 
to  restrict  the  individuals  who  practice,  but  to  offset  the 
ignorance  of  the  public  employing  the  physicians.  Educa- 
tion of  the  public  as  to  a  basis  of  selection  is  the  real  point 
to  be  desired,  rather  than  undue  restriction.  The  more 
clearly  the  elements  of  quaHfication  and  competency  can  be 
set  forth  in  this  classification,  the  greater  will  be  the  influ- 
ence upon  the  minds  of  the  public. 

Of  course,  the  objection  to  the  plan  is  that  it  will  leave 
in  practice  a  very  large  number  of  incompetent  physicians. 
Those  who  are  looking  into  this  are  disposed  to  think  that 
the  number  will  be  no  greater  under  that  plan  than  under 
the  present  plan.  With  all  its  drawbacks,  however,  it  will 
have  the  merit  of  furnishing  a  reliable  list  of  medical  men 
whose  qualifications  have  been  in  fact  determined. 

This  can  not  be  said  of  any  list  now  in  existence,  deter- 
mined by  any  governmental  process. 


326  HENRY     BAIRD     FA  V  ILL 

Several  subordinate  questions,  however,  arise:  First, 
what  shall  be  the  distinction  whereby  the  difference  between 
an  accredited  man  and  a  non-accredited  man  may  become 
obvious  and  easily  recognized?  Second,  shall  there  be  a 
distinction  between  the  accredited  class  and  others,  with 
reference  to  their  standing  in  court,  for  example?  Third, 
shall  all  who  wish  to  go  into  the  practice  of  medicine  submit 
to  a  State  examination,  the  successful  ones  being  accredited 
and  the  non-successful  ones  being  non-accredited,  but  still 
allowed  to  practice?  Fourth,  if  this  examination  shall  not 
be  compulsory  upon  all  candidates,  but  voluntary  for  ac- 
crediting, shall  a  standard  be  adopted  as  to  the  quality  of 
the  medical  school  issuing  the  diploma  in  question? 

These  are  questions  of  great  importance  in  formulating  a 
plan  for  practical  application.  They  are  not  at  all  important 
in  the  consideration  of  the  general  principles  involved.  If 
one  were  to  approach  this  problem  anew,  without  practical 
experience,  it  would  be  difficult  to  say  which  plan  would 
offer  the  best  results.  In  fact,  the  history  of  medical  legis- 
lation thus  far  indicates  that  a  priori  judgment  leads  to  the 
adoption  of  restrictive  or  licensing  methods.  It  is  perhaps 
as  a  reaction  due  to  the  disappointing  results  in  medical 
legislation,  that  one's  mind  turns  again  to  the  underlying 
principles.  In  the  end  the  moral  quality  in  legislation  de- 
termines its  permanent  effectiveness. 

All  things  considered,  I  believe  that  there  is  a  deeper 
ethical  note  in  public  movements  which  encourage  indi- 
vidual judgment  and  choice  than  in  those  which  introduce 
more  or  less  mandatory  influence.  Upon  a  foundation  of 
that  sort,  the  effort  of  the  State  to  make  clear  the  conditions 
of  choice  for  its  citizens,  becomes  its  highest  and  presum- 
ably its  most  influential  service. 

The  exigencies  of  civic  life  can  be  met  by  the  exercise 
of  police  power,  fluctuating  with  the  spirit  of  the  time.  The 
early  history  of  reform  movements  may  be  of  necessity 
marked  by  arbitrary  and  restrictive  measures.     As  a  feature 


M  IC  I)  IC  I  N  l<:      AND      IMJ  lU,  I  C       H  lO  A  I.  T  II  327 

of  permanent  and  well  conslnictcd  society,  however,  that 
custom  whi(;h  rests  upon  widespread  intelHgence  is  the  only 
custom  which  can  be  expected  to  endure. 

The  merits  of  the  suggestion  which  I  make  are  simply 
three : 

1.  The  highest  degree  of  individual  freedom. 

2.  I'he  highest  standard  of  classification  as  a  guide  to 
public  judgment. 

3.  Limitation  of  the  stamp  of  approval  or  employment 
by  the  State  to  individuals  whose  qualifications  have  been 
actually  determined. 

I  revert  now  to  the  subject  of  this  paper,  "The  Attitude 
of  the  Medical  Profession  Regarding  Medical  Practice 
Laws."  Does  the  matter  as  I  have  stated  it  represent  the 
personal  attitude  of  the  profession?  I  think  I  may  safely 
say  that  it  does  not.  Ought  the  medical  profession  to  assume 
this  attitude  in  the  matter?     It  seems  to  me  that  it  ought. 

Again  I  repeat  the  principle  which  seems  to  me  to  under- 
lie medical  practice  legislation  from  the  standpoint  of  the 
medical  profession.  I  believe  there  is  but  one  ground  upon 
which  to  justify  interest  and  agitation  in  that  matter  on  the 
part  of  the  profession.  That  ground  is  protection  of  pubhc 
interest.  If  the  principle  here  set  forth  is  sound,  and  the 
proposition  founded  upon  it  can  be  regarded  as  finally  and 
deeply  contributing  to  public  welfare  in  medical  affairs,  the 
rights  and  purposes  of  the  medical  profession  are  adequately 
secured.  How  much  of  an  effort  will  be  required  to  elimi- 
nate the  idea  of  self -protection  and  self-interest,  one  can  not 
know.  How  long  it  will  take  to  sw4ng  away  from  the  simple 
and  obvious  plan  of  restriction  through  license,  to  the 
broader  and  more  indirect  plan  of  influencing  and  educating 
by  a  process  of  accrediting,  no  one  can  tell.  The  longer 
the  time  in  prospect  necessary  to  effect  this  change  in 
sentiment,  the  sooner  we  should  be  at  it.  Aly  oaati  feeling 
about  it  is  distinctly  in  favor  of  the  plan  which  I  have 
superficially  sketched. 


328  HENRY     BAIRD     FAVILL 

Printed,  The  Sttrvey,  September  3,  1910. 

THE   TOXIN   OF   FATIGUE 

WE  are  told,  and  we  have  come  to  think,  that  the 
chief  reason  why  reforms  in  social  affairs,  be  they 
political  or  other,  are  spasmodic  and  evanescent, 
lies  in  the  character  of  the  agencies  which  inaugurate  move- 
ments for  correction  of  abuses.  The  idea  prevails  that  the 
forces  of  selfishness  are  always  alert,  aggressive,  and  organ- 
ized, and  the  forces  of  reform  are  unorganized,  and  tem- 
porary in  their  purpose.  This  is  probably  very  true.  There 
are  other  elements,  however,  of  great  importance  in  deter- 
mining the  lack  of  consistent  and  stable  progress  character- 
istic of  social  reforms. 

As  a  rule,  foundations  of  reform  movements  are  not 
broad  enough.  Frequently  they  are  not  sound  enough. 
No  movement  involving  the  whole  people  goes  far  that  does 
not  reckon  accurately  with  human  nature.  No  movement 
can  stand  which  has  not  unfailing  truth,  unequivocal  fact, 
as  its  foundation. 

In  order  to  have  success  at  all  there  must  be  satisfied 
that  human  need  which  we  may  call,  without  reflection  or 
reproach,  sentimental.  In  order  to  have  permanence  and 
ultimate  respect  there  must  be  met  the  requirements  of 
intellectual  approval.  Whatever  is  done  ultimately  har- 
monizes and  utilizes  both  of  these  factors  in  human  affairs. 

It  is  very  obvious  that  the  trend  of  social  development 
is  progressive.  It  appears  to  be  true  that  efforts  at  reform 
and  even  radical  reconstruction  are  accorded  a  measure  of 
respect  and  cooperation  far  beyond  what  a  few  years  ago 
would  have  been  possible.  The  reason  for  this,  to  a  con- 
siderable extent,  lies  in  the  sagacity  of  the  builders.  They 
have  come  to  see  that  unquestionable  fact  is  the  corner 
stone    of    any     structure.     No    great    movement    is    now 


M  K  I)  I  (•  I  N  f'",      AND      I'  (I  IM,  I  r      |[  I-;  A  I,  I   l(  329 

iindcrLakcn  hy  intcllij^cnl  persons  wiUiDiit  systematic  effort 
to  determine  the  facts  relating  to  the  subject.  Rational  as 
this  is,  it  must  be  admitted  that  as  a  distinct  and  pre- 
dominating feature  of  social  movements  it  is  compara- 
tively new. 

The  gathering  of  data  of  critical  accuracy  is  for  the  most 
part  preliminary  work.  It  is  the  work  of  individuals,  of 
small  groups,  of  unseen  hands,  actuated  and  inspired  by 
clear  social  vision.  There  remains  always  to  be  accom- 
plished organization  for  the  purpose  of  making  effective 
the  moral  value  which  such  results  embody.  Here  opens 
up  before  us  all  the  fine  art  of  propaganda,  the  unlimited 
field  of  the  social  worker. 

As  I  have  intimated,  at  this  point  there  comes  in  a  grave 
danger  —  the  danger  that  popular  passion  shall  be  substi- 
tuted for  intelligent  motive  and  utilized  to  extravagant 
ends.  The  effective  checks  upon  this  tendency  are  clear- 
ly defined  data  coupled  with  the  determination  that  fancy 
shall  be  made  to  square  with  fact. 

Scientific  accuracy  is  greatly  to  be  desired  in  all  dis- 
cussions subject  to  the  illumination  of  science.  Accurate 
determination  of  underlying  facts  is  obligatory  upon  those 
who  undertake  constructive  movements.  The  fullest  array 
of  information  having  definite  scientific  value  and  bearing 
upon  such  questions  as  social  reform  is  in  the  utmost  degree 
desirable.  It  must  be  recognized,  however,  that  there  are 
matters  of  human  interest  and  enormous  social  importance 
which  are  only  partially  open  to  scientific  interpretation, 
and  with  regard  to  which  methods  of  adjustment  must  be 
found  other  than  purely  scientific. 

Considerable  interest  has  been  evoked,  and  some  meas- 
ure of  encouragement  expressed,  by  reason  of  the  fact  that 
there  has  been  rather  conclusively  determined  through  lab- 
oratory researches  the  fact  that  fatigue  has  a  certain  defin- 
iteness  of  nature  and  degree  hitherto  not  fully   realized. 

It  has  been  conceived  that  if  fatigue  could  be  made  a 


330  HENRY     BAIRD     FAVILL 

ponderable  quantity,  accurately  measured  and  accounted 
for,  it  would  be  a  long  step  toward  meeting  the  j^roblems 
related  to  fatigue. 

There  have  been  advanced,  consequently,  valuable  prop- 
ositions dealing  with  the  physiologic  aspects  of  fatigue. 
For  a  great  while  it  has  been  believed  that  living  machinery 
showed  a  tendency  to  flag  in  its  operations,  not  because  of 
exhaustion  of  certain  vital  principles,  but  because  of  an 
accumulation  of  the  products  of  work.  In  other  words, 
not  that  the  machinery  was  exliausted,  but  that  it  was 
choked. 

There  is  a  great  deal  of  truth  in  this  view.  Physiology 
is  an  extraordinarily  complicated  subject  and  our  knowl- 
edge of  it  in  its  ultimate  facts  is  meager.  There  are  certain 
broad  principles,  however,  which  are  not  only  obvious,  but 
which  stand  the  test  of  all  physiologic  investigation  that  we 
have. 

A  machine  which  is  at  the  same  time  building  up  and 
tearing  down  must  have,  if  it  is  to  maintain  its  integrity,  a 
very  delicate  mechanism  of  balance  which  insures  not  only 
processes  of  construction  and  destruction  but  processes  of 
introduction  of  usable  materials  and  elimination  of  used 
materials.  It  may  perhaps  not  be  generally  understood 
that  a  living  organism  can  exist  many  times  longer  without 
nourishment  than  it  can  without  elimination.  Any  living 
organism  will  die  promptly  if  the  waste  products  from  its 
life  processes  accumulate;  in  other  words,  if  there  is  non- 
eHmination.  So  it  is  undoubtedly  true  that  an  organism 
can  be  choked  by  the  products  of  its  own  life  activities. 

It  is  well  to  remember  that  these  vital  processes  in  the 
human  animal  are  distinctly  of  two  kinds.  All  of  the  things 
which  we  do  in  our  conscious  activity  —  work,  play,  and 
thought  —  are  matters  of  voluntary  effort.  They  are  things 
of  which  we  are  conscious,  over  which  we  have  control. 
They  constitute  what  we  have  in  mind  when  we  speak  of 
our  activities.     When  we  consider  labor  we  are  thinking 


MEDIC  I  NIC      ANT)      IM;  H  L  I  C      iri-,  Ar.TFf  331 

solely  of  .'I  voliinlary  expenditure  of  cncrj^y,  but  on  the 
other  .side  of  this  balance  lie  all  those  processes  which  are 
involuntary,  unconscious,  unrecognized;  they  are  the  nutri- 
tive processes,  the  so-called  veji^etative  processes,  and  are 
things  utterly  beyond  our  control. 

In  dealing,  then,  with  any  physiologic  problem,  such  as 
the  problem  of  fatigue,  we  are  really  dealing  with  factors 
over  which  we  have  various  degrees  of  control.  Normally 
we  can  measure,  increase,  or  decrease,  our  voluntary  efforts. 
Life  is  made  up  of  the  interplay  of  voluntary  efforts,  but 
over  our  vegetative  process  we  have  neither  control  nor 
have  we  immediate  consciousness  of  the  processes.  Under 
normal  conditions  vegetative  life  is  automatic,  adequate, 
and  with  a  large  range  of  accommodation  to  physiologic 
demands.  Under  abnormal  conditions,  these  factors  mark- 
edly diminish  so  that  the  processes  of  nutrition,  elimina- 
tion, and  repair  become  variously  diminished  and  open  to 
all  manner  of  disturbances  which  we  are  prone  to  regard 
as  disease. 

Experience  shows  and  experiment  verifies  that  not  only 
is  vegetative  life  necessarily  taxed  with  sustaining  volun- 
tary life,  but  voluntary  life  can  through  excess  or  perversion 
not  only  throw  more  work  upon  vegetative  life  than  it  can 
accomplish,  but  also  in  this  very  process  distinctly  limit  the 
work  that  vegetative  functions  can  perform. 

It  is  very  eas}^  to  see,  therefore,  that  under  given  con- 
ditions labor  can  be  pushed  to  a  point  beyond  that  at  which 
vegetative  life  can  meet  it.  If  in  addition  to  that  fact  we 
admit  that  this  excessive  demand,  long  continued,  greatly 
limits  vegetative  power,  we  can  easily  conceive  a  status 
in  which  the  products  of  work,  which  we  call  "waste  prod- 
ucts," are  more  than  the  normal  mechanism  can  dispose 
of.  Beyond  a  certain  point  the  demand  for  elimination 
and  the  effort  to  eliminate  cease  to  go  hand  in  hand.  From 
that  time  on,  though  the  demand  be  never  so  great,  the 
response  becomes  progressively  less. 


332  HENRY     BAIRD     FAVILL 

Out  of  that  combination  of  facts  can  arise  any  degree 
of  physiologic  poisoning  which  we  have  come  to  call  "toxic," 
and  there  is  no  doubt  that  upon  these  simple  lines  there  is  a 
distinct  body  poisoning  in  accordance  with  these  principles. 

There  is  reason,  however,  to  believe  that  the  products 
of  labor,  particularly  muscular  labor,  are  not  entirely  due 
to  accumulated  waste.  Laboratory  research,  verified  by 
many  competent  observers,  indicates  that  there  is  created 
in  the  process  of  muscular  work,  and  perhaps  in  the  process 
of  mere  mental  and  nervous  work,  substances  of  a  nature 
distinctly  poisonous,  which  have  been  designated  as  "toxic," 
the  so-called  "toxin  of  fatigue."  From  a  physiologic  point 
of  view  this  is  very  important.  The  bearing  of  it  upon  life 
processes,  cellular  activity,  ultimate  chemistry,  nervous  con- 
trol, and  organic  breakdown,  is  very  great,  but  it  is  after  all 
distinctly  a  physiologic  question,  at  the  moment  stib  judice, 
and  for  practical  purposes  not  material  to  our  hand,  though 
as  a  factor  in  the  development  of  general  intelligence  upon 
the  subject  of  work  it  has  great  value. 

Scientific  determination  always  is  in  the  rear.  Human 
experience  has  blocked  out  and  worked  out  the  field  of 
human  interests  long  before  fundamental  reasons  have 
been  determined.  Scientific  demonstration  comes  after- 
ward, explaining,  illuminating,  correcting,  stimulating,  but 
rarely  pointing  the  way.  So  we  shall  find  in  the  discussion 
of  our  own  problem  that  scientific  fact  here  and  there 
developing  operates  to  strengthen  the  belief  in  that  which 
is  sound,  and  to  correct  the  weakness  in  that  which  is 
unsound,  but  by  no  possibility  now  can  it  be  substituted 
for  the  lessons  of  experience  in  dealing  with  this  most  vital 
of  human  problems. 

This  should  be  no  disappointment  to  the  lovers  of  scien- 
tific demonstration  and  accuracy.  It  is  true  in  all  direc- 
tions. The  study  of  tuberculosis  received  its  greatest  im- 
petus from  the  discovery  of  the  micro-organism  which  is 
the  immediate  cause  of  tuberculosis,  but  the  problem  of 


MEDICI  NIC      A  N  F)      IMMJKIC      IIKAI.TH  333 

dealinj^  with  tuberculosis  has  j^onc  o]]  under  this  stimulus 
to  the  point  of  enormous  efficiency  with  scarcely  any  assist- 
ance from  scientific  knowledj^e  of  this  organism.  Aside 
from  the  fact  that  quarantine  is  simpler  and  more  effective 
because  of  our  knowledge,  the  tuberculosis  question  could 
stand  on  the  product  of  experience,  irresjjective  of  what 
we  know  of  the  germ,  or  its  damaging  efTects.  Although 
this  may  not  always  be  true  of  the  relationship  between 
scientific  discovery  and  common  experience,  it  is  in  most 
directions  true  now,  and  the  world  cannot  wait  for  any 
other  relationship  to  be  established. 

We  know  enough  as  to  the  physiologic  bearings  of  fa- 
tigue to  enable  us  to  deal  wisely  and  thoroughly  with  the 
subject.  Let  the  search  for  truth  in  the  laboratory  go  on, 
a  stimulus  to  critical  study,  a  help  to  hygienic  living  and  a 
corrective  to  false  physiology'-,  but  the  wear  and  tear  of  the 
worker  must  speak  for  itself  in  terms  of  common  experience. 

What  is  this  common  experience  with  which  our  views 
of  fatigue  must  square?  As  one  views  the  intricate  activi- 
ties of  civilized  life,  it  seems  as  though  it  were  almost  too 
complex  to  discuss.  For  one  living  according  to  the  most 
complicated  type  to-day,  the  elements  of  fatigue  seem  so 
interwoven  as  to  be  inextricable.  The  combination  of 
mental  and  physical,  ambition  and  worr3^  mal-nutrition 
and  want,  demoralization  and  degeneracy  makes  composite 
factors  difficult  to  analyze.  We  are  far  from  having  at- 
tained such  physiologic  and  psychologic  knowledge  as  en- 
titles us  to  final  opinions  upon  many  of  these  questions. 
There  are,  however,  obvious  lines  upon  which  to  proceed, 
and  the  more  limited  the  field  of  inquiry'  the  fewer  main 
paths  there  are  to  traverse  in  a  preliminan,'  study. 

I  desire  to  keep  clear  of  theory  involving  the  occult  in 
physiology  or  psychology.  I  desire  to  pass  by  every  panacea 
offered  in  solution  of  our  human  difficulties. 

The  purpose  of  this  discussion  is  to  further  the  estab- 
lishment of  fatigue  as  a  factor  in  standardizing  the  number 


334  HENRY     B  A  I  R  D     F  A  V  I  L  L 

and  arrangement  of  hours  of  labor.  It  is  not  purely  merci- 
ful or  perhaps  primarily  merciful,  but  fundamentally  an 
attempt  to  economize  the  powers  of  our  working  popula- 
tion. It  is  desirable,  therefore,  that  we  clarify  so  far  as 
we  may  our  notion  of  fatigue  and  separate  it  into  its  various 
aspects. 

Fatigue  is  a  comprehensive  term  and  not  particularly 
valuable  as  related  to  our  purpose.  It  is  a  mistake  to  con- 
sider that  overwork  and  fatigue  necessarily  coincide.  It 
is  a  mistake  to  believe  that  sufficiently  clear  evidences  of 
fatigue  arise  directly  in  connection  with  unduly  strenuous 
labor.  The  elements  entering  into  the  question  of  labor  as 
related  to  endurance  are  complex.  For  example,  much  of 
the  heaviest  labor  from  the  standpoint  of  physical  exertion 
is  not  associated  habitually  with  an  immediate  sense  of 
exhaustion,  even  though  its  ultimate  results  be  very  de- 
structive. Heavier  trades,  such  as  iron-workers,  black- 
smiths, and  many  others,  and  even  the  activities  of  certain 
forms  of  athletics,  are  not  characterized  by  any  marked 
fatigue,  and  yet  they  are  beyond  question  extremely  destruc- 
tive to  the  human  organism.  The  great  increase  in  strength, 
bulk,  activity,  and  perhaps  vitality,  incident  to  these  stren- 
uous occupations,  not  only  does  not  mitigate,  but  on  the 
contrary  rather  accelerates  destructive  organic  changes  and 
serves  to  deprive  them  of  the  protective  and  conservative 
influence  of  fatigue. 

The  problem  presented  hereby  is  one  of  great  practi- 
cal difficulty.  Picture  the  difficulty  of  persuading  a  black- 
smith, who  is  able  to  do  his  full  day's  work  without  conscious 
fatigue,  that  his  whole  method  of  labor  should  be  modified 
with  respect  to  a  deterioration  far  in  the  future.  Yet  there 
is  not  the  least  doubt  that  if  the  logical  course  of  standardi- 
zation is  pursued,  just  such  a  question  as  that  must  arise. 
The  immediate  questions  before  us  will  be  simpler  because 
more  obvious. 

What  do  we  mean  by  fatigue?     I  think  it  is  a  mistake 


M  10  I)  I  C  I  N  !•:      A  N  F)      IM'HI.  K       [l  i:  A  I.  J   11  ^.35 

to  consider  the  various  manifestations  of  fatigue  as  merely 
matters  of  degree.  The  wear  and  tear  upon  the  organism 
comes  in  so  many  ways  and  through  such  various  phases 
that  it  is  hardly  comprehensible  if  we  simply  treat  it  as  a 
gradation.  We  assume  that  an  individnal  who  is  tired  will 
recuperate  with  rest.  Under  the  simplest  conditions  this 
is  true.  It  is  not  conceivable  that  there  is  a  degree  of 
fatigue  which  has  no  structural  relation.  The  fact  that 
our  means  of  observation  are  not  sufficient  to  show  us 
what  the  structural  change  is,  merely  argues  our  limitation. 
It  is  to  aSvSume  that  even  the  simplest  fatigue  has  a  change 
in  cellular  structure  which  under  ordinary  circumstances 
rapidly  returns  to  the  normal.  It  is  undoubtedly  true  that 
conditions  of  prolonged  tax  with  exhaustion  produce  struc- 
tural cellular  change  which  does  not  easily  or  rapidly  return 
to  the  normal.  Between  these  extremes  there  are  doubt- 
less all  degrees,  but  our  practical  questions  can  not  rest 
upon  a  simple  schematic  basis  like  that.  We  have  got  to 
weigh  and  measure  fatigue  as  related  to  the  specific  con- 
ditions under  which  it  occurs.  The  problem  is  individual 
in  each  instance.  The  character  of  work,  age,  sex,  vitality, 
and  material  conditions  of  the  worker  must  be  weighed 
together. 

It  is  not  a  mechanical  problem,  it  is  not  a  mere  physical 
problem.  It  is  distinctly  a  human  problem  in  which  the 
interrelation  of  physical,  mental,  and  industrial  needs  must 
be  intelligently  interpreted. 

Doubtless  this  interpretation  w411  proceed  irregularly 
and  unsymmetrically  along  the  lines  of  least  resistance. 
We  have  seen  this  clearly  foreshadowed  in  the  movement 
against  child  labor,  followed  markedly  by  the  movement 
to  limit  the  labors  of  women.  These  in  turn  will  be  suc- 
ceeded by  movements  arising  as  the  necessity  for  them  be- 
comes more  obvious.  Nevertheless,  no  single  movement 
along  these  lines  can  be  regarded  as  final,  nor  even  ver\- 
useful  except  as  it  establishes  beyond  question  recognition 


336  HENRY     B  A  I  R  D     F  A  V  I  L  L 

of  the  principle  that  labor  is  a  human  function  and  intended 
to  elevate  and  not  to  degrade  the  race. 

Every  detail  that  can  be  worked  out  in  building  up  an 
industrial  system  that  squares  with  this  ethical  conception 
will  be  of  value  and  immutable,  but  far  in  the  distance  lies 
that  point  at  which  all  of  these  ideas  will  be  gathered  to- 
gether, correlated,  and  made  to  serve  the  real  interests  of 
humanity.  In  the  meantime  we  must  strive  point  by  point 
to  clarify,  demonstrate,  and  make  effective,  ideas  looking 
to  this  end. 

Long  ago,  students  of  industrial  conditions  came  to  rec- 
ognize as  a  type  the  individual  who  is  ' '  spent ' '  by  reason  of 
undue  labor  before  rriaturity.  We  have  hardly  yet  grasped 
the  idea  that  the  same  factors  showing  acutely  in  the  results 
upon  the  immature,  operate  somewhat  less  manifestly  in 
all  laborers. 

The  two  factors,  specialization  and  economy  of  pro- 
duction, are  bringing  us  to  an  industrial  crisis  which  will 
have  to  be  reckoned  with.  Specialization  means  beyond 
doubt  industrial  effectiveness,  but  its  counterbalance  is 
monotony.  Economy  of  production  means  especially  econ- 
omy of  time,  but  its  counterbalance  is  "speeding  up." 
Out  of  these  two  factors  arise  the  great  offenses  against 
human  endurance  and  community  welfare. 

Both  of  these  factors  must  be  interpreted  in  the  light  of 
psychologic  fact.  The  ultra-monotonous  labor,  by  reason 
of  its  lack  of  conscious  constructive  quality,  fails  utterly 
to  introduce  into  the  personal  equation  of  the  laborer  the 
compensating  factor  of  intelligent  interest.  The  "speed- 
ing up"  process  particularly  related  to  this  work,  must  be 
weighed  in  the  light  of  its  mental  strain.  Of  the  two, 
beyond  doubt  the  "speeding  up"  process  is  the  more  de- 
structive as  a  mere  physical  proposition,  but  as  related  to 
individual  development  or  happiness  or  inspiration  it  is 
not  so  clear  that  monotony  is  not  the  worse. 

It  is  quite  possible  for  either  of  these  lines  to  be  pursued 


M  10  I)  1  ('  I  N  K      A  N  I)      I'  I     i;  I.  I  c      II  I.  A  I.  I   If  337 

willioiiL  any  very  conscious  fali^Mic  until  a  ^reat  damage 
has  been  done.  The  elements  entering  into  personal  atti- 
tude toward  work  are  so  complex  that  one  can  scarcely 
forecast  in  ])articu]ar  how  things  will  work  out,  hut  wide 
observation  shows,  as  a  general  proposition,  that  in  many 
lines  of  industry  there  is  an  enormous  sacrifice  of  indi- 
viduals upon  this  altar  of  economical  production. 

It  is  clear,  then,  that  any  questions  of  time  as  a  meas- 
ure of  a  day's  labor  must  be  established  in  relation  to  the 
character  of  the  labor. 

Fatigue  is  viciously  progressive.  When  it  has  passed  a 
given  point  there  are  at  least  three  general  considerations: 
first,  the  actual  structural  change  due  to  over-tax  and  ex- 
penditure; second,  the  impairment  of  nutritive  processes 
distinctly  limiting  assimilation  and  repair;  third,  the  ac- 
cumulation of  poisonous  products  incident  to  the  operation 
of  the  two  preceding.  Taken  all  together,  we  have  an 
overwhelming  incubus  which  no  organism  can  long  survive. 

Are  we  going  to  meet  this  situation  by  the  enactment 
of  child  labor  laws?  We  are  not.  Are  we  going  to  meet 
it  by  the  enactment  of  laws  limiting  the  hours  of  work  of 
women?  We  are  not.  How  then  are  we  likely  to  progress ? 
By  the  creation  of  a  new  industrial  conception.  By  the 
establishment  of  the  principle  that  human  industry  is  only 
beneficent  in  so  far  as  it  evokes  and  utilizes  the  largest 
individual  powers  for  the  longest  time.  Any  conception 
which  makes  material  production  paramount  to  the  essential 
interest  of  the  units  entering  into  that  production  can  only 
aggravate  our  present  condition  and  accelerate  an  inevitable 
disaster. 

The  chief  factor  entering  into  the  determination  of  this 
problem  is  the  factor  of  endurance.  The  subordinate  factors 
are  happiness  and  harmony,  but  fatigue,  manifest  or  hidden, 
is  the  essence  of  this  question. 

You  will  gather  from  this  very  cursory  discussion  my 
reservations  upon  the  topic  of  this  article.     Not  only  is  our 


338  HENRY      BAIRD     FAVILL 

present  knowledge,  chemical  and  biologic,  as  to  the  "toxin 
of  fatigue"  insufficient  to  furnish  us  any  practical  data,  but 
further,  it  is  exceedingly  ill-advised  to  attempt  to  establish 
working  formulae  upon  any  foundation  so  ill-secured.  In 
so  far  as  progress  in  industrial  matters  is  to  be  furthered  by 
legislative  action,  what  is  presented  must  carry  conviction 
to  the  ordinary  intelligent  mind.  Propaganda  based  upon 
hypothesis,  half-truth,  or  partially  determined  scientific 
knowledge,  are  dangerous.  The  laboratory  developments 
upon  this  subject  are  stimulating  and  helpful.  They  can 
not  at  present  be  used  either  effectively  or  with  safety  in 
a  practical  effort  to  correct  the  abuses  of  our  social  life. 

When  I  discredit  in  this  way  laboratory  results,  I  do  not 
at  all  discredit  the  laboratory  idea.  It  is  beyond  all  things 
the  idea  which  we  most  need  at  this  moment  to  establish 
a  foundation  for  industrial  reform.  It  cannot,  however, 
be  the  chemical  laboratory  or  the  physiologic  laboratory, 
except  as  a  minor  adjunct.  Our  laboratory  is  the  human 
laboratory,  the  field  of  operation,  the  individuals  who  make 
up  our  industrial  life — it  is  the  shop,  the  office,  the  factory, 
and  the  mine.  What  is  needed  above  all  things  as  bearing 
upon  this  question  is  comprehensive  and  profound  study 
of  the  conditions  of  labor,  particularly  with  reference  to  the 
question  of  human  endurance.  This  means  an  accurate, 
analytical  study  of  work  as  it  is  done  where  it  is  done, 
freely  regarding  all  of  the  collateral  conditions  under  which 
workers  live.  With  this  modification  I  am  convinced  that 
laboratory  work  as  a  foundation  for  industrial  reform,  one 
phase  of  which  is  the  standardization  of  hours  of  labor,  is 
fundamental. 

Fatigue  must  be  approached  from  the  standpoint  of  its 
results,  obvious  and  demonstrable  to  the  intelligent  mind. 
The  chemistry  of  fatigue  must  be  a  side  issue.  Given  any 
such  exhaustive  research  into  the  ultimate  facts  of  labor- 
ing conditions,  we  shall  have  acquired  a  fund  of  knowledge 
upon   which   can   safely    be  built   an  elaborate   system  of 


MKDICINTC      AND     IMJ  B  [,  I  f     M  KM.  ill         339 

industrial  hygiene.  If,  however,  we  harl  at  hand  now  the  in- 
formation necessary  t(j  a  general  conscientious  attack  upon 
this  prol)lem,  we  would  still  be  far  from  great  achievement. 

The  second  factor,  which  I  have  before  mentioned,  must 
be  secured.  Popular  belief  in  the  principle  and  doctrine 
that  we  stand  for  is  a  necessary  antecedent  condition.  It  is 
not  likely  that  a  great  change  in  the  conception  of  industrial 
morality  can  take  place  abruptly.  It  is  likely  that  a  long 
series  of  experiments,  advances,  retreats,  and  half-victories 
will  mark  the  progress  of  the  next  few  years. 

It  is  necessary,  however,  that  those  agencies  in  society 
assuming  responsibility  for  these  movements,  and  array- 
ing public  influence  in  furtherance  of  them,  should  proceed 
consciously,  unerringly,  and  without  essential  compromise 
toward  the  establishment  of  an  ethical  conception  of  labor 
and  its  relation  to  life.  Properly  combined  with,  and  re- 
inforced by  a  mass  of  honestly  determined  facts,  this  phase 
of  the  matter  can  not  be  discredited  by  being  called  senti- 
mental. 

Unless  backed  and  fortified  by  clearly  determined  facts, 

a  sentimental  campaign  will  fail,  but  all  the  research  and 

determination  of  fact  conceivable  will  fall  far  short  of  its 

achievement,  except  as  it  is  vitalized  and  promulgated  by 

^  the  deepest  moral  sentiment  of  the  people. 


340  HENRY      B  A  I  R  D     F  A  V  I  L  L 


Delivered,  International  Prison  Congress,  Washington,  D.  C,  1910. 

THE  MANAGEMENT  OF  DEFECTIVE   CHILDREN 

HOWEVER  great  the  difficulty  of  establishing  princi- 
ples upon  which  the  defectives  of  society  shall  be 
managed,  a  more  difficult  and  more  important  ques- 
tion is,  What  shall  be  the  attitude  of  society  in  general 
toward  the  defective? 

Civilization  has  definitely  planted  itself  upon  the  ground 
of  securing  and  maintaining  the  survival  of  the  unfit,  recog- 
nizing that  the  term  "unfit"  has  merely  a  biologic  value 
and  neither  a  sociological  or  ethical  value. 

If  it  could  be  reasoned  from  this  discussion  that  the 
right  to  procreate  was  inherent  in  the  right  to  exist,  there 
would  be  little  question  that  no  separation  could  exist  be- 
tween a  biologic  and  sociologic  value.  It  seems  inevitable 
that  we  shall  make  this  definition  more  sharp  rather  than 
less,  and  that  as  we  progress  we  shall  more  rigidly  protect 
and  cherish  the  individual  during  his  life,  and  more  reso- 
lutely and  definitely  determine  that  this  influence  shall 
cease  with  his  life.  The  question  of  care  of  defectives  must 
turn  largely  upon  this  issue. 

If  society  is  to  permit  degeneration  to  proceed  unre- 
strained and  free-handed,  it  has  no  excuse  at  all  for  this 
struggle  to  make  safe  or  comfortable  or  prolonged  the 
lives  of  its  weak  and  unfortunate. 

The  problem  of  procreation  of  defectives  is  still  to  be 
solved.  The  problem  of  the  care  of  defectives  is  upon  us. 
Assuming  that  the  future  will  see  a  solution  of  the  former 
problem  and  that  it  will  be  consistent  with  the  principle 
stated,  it  leaves  us  to  decide  how  best  to  handle  the  defec- 
tive with  reference  to  his  present  existence. 

Society  is  still  unfolding  its  conception  of  custodial  care, 
and,  great  as  the  advance  has  been  since  the  days  of  ' '  Bed- 
lam," much  greater  will  be  the  advance  toward  rational  and 


M  fo  I)  I  (•  I  N  E     AND     IMP,  i.rr     III:  A  I,  Til        341 

humane  ;i,(ltm'nislr.'i.t,i()n.  Any  cai-clnl  analysis  on  the  basis 
of  the  normal  and  departure  from  the  normal  shows  the 
inherent  difficulty  of  determining^  what  shall  be  considered 
defective.  Practically,  under  our  ];resent  conceptions,  those 
who  are  sufficiently  defective  to  need  custodial  care  are 
reasonably  accurately  determined  by  conditions  of  economic 
dependence.  But  experience  .shows  clearly  enough  that 
test  to  be  insufficient.  On  the  one  hand,  much  assistance 
that  could  be  rendered  looking  to  lessening  of  defectives 
is  omitted,  and  on  the  other,  individuals  are  given  full 
freedom  and  prerogative  in  society,  who  should  be,  for  the 
sake  of  future  generations,  somewhat  restricted. 

The  whole  situation  calls  for  a  more  far-seeing  policy, 
and  amongst  the  factors  which  are  necessary  to  handling  the 
problem  are  to  be  counted  the  institutions  of  various  kinds 
which  directly  or  indirectly  deal  with  these  individuals. 

The  question  to  which  I  address  myself  here  is  limited. 
Shall  various  institutions  be  definitely  and  solely  devoted 
to  the  welfare  of  defectives  or  shall  the  management  and  cul- 
ture of  such  unfortunates  be  a  function  of  institutions  more 
generally  administered  ? 

The  question  proposed  was  further  qualified  by  speci- 
fying defectives  having  "dangerous  moral  tendencies."  It 
must  be  apparent  that  such  qualifying  is  neither  definite 
nor  significant.  Broadly  considered  no  one  can  define  what 
are  strictly  dangerous  moral  tendencies,  and  experience 
shows  invariably  that  all  defectives  are  more  or  less  liable 
to  such  developments.  Practically,  the  question  must  re- 
main as  to  the  proper  care  of  defectives,  not  only  with 
reference  to  their  developed  moral  obliquities,  but  with 
regard  to  the  prevention  of  these  developments.  The  best 
policy  with  respect  to  that  aspect  of  the  matter  must  be 
determined  for  the  most  part  by  the  relation  which  the 
policy  bears  to  prevention  rather  than  to  mere  restriction. 

There  are  at  least  two  questions  involved  herein: 
First,  which  method  will  produce  the  best  results  for  the 


342  HENRY     BAIRDFAVILL 

individual?  Second,  which  is  best  calculated  to  meet  the 
necessities  of  society,  especially  in  respect  to  the  limitation 
and  prevention  of  defectives? 

This  siibject  offers  no  exception  to  the  rule  that  effective 
dealing  with  human  development  varies  directly  as  the  in- 
timacy of  knowledge  of  the  individual.  If  the  persons  in 
charge  of  defectives  in  this  troublesome  class  can  better 
and  more  intimately  know  the  individual  presentation 
upon  one  plan  or  the  other,  a  decision  as  to  effectiveness 
is  at  that  point  measurably  determined. 

It  is  questionable  whether  dangerous  tendencies  are 
fundamental  moral  defects.  In  competent  hands  they  can 
frequently  be  ehminated.  In  incompetent  hands  they  can 
almost  always  be  developed.  These  are  far  more  matters 
of  accident,  opportunity,  and  imitation  than  of  primarily 
moral  perversion.  This  in  turn  emphasizes  the  value  of 
individual  acquaintance  and  insight,  and  again  the  question 
recurs,  On  what  plan  can  these  best  be  secured? 

Administration,  such  as  is  here  contemplated,  is  essen- 
tially educational.  All  educators  agree  that  the  essence  of 
successful  education  is  a  sufficiently  small  unit.  For  that 
reason,  if  for  no  other,  any  plan  which  differentiates  a  class 
of  individuals  upon  the  ground  of  specific  characters  is  to 
be  favored. 

To  any  extent  that  defectives  can  be  grouped  rationally, 
a  method  of  dealing  with  the  group  of  administrative  forces 
will  be  developed.  Only  upon  wise  classification  can  the 
highest  level  of  efficiency  be  reached,  so  far  as  concerns  the 
individuals  in  question. 

This  phase  of  the  subject  requires  no  argument.  Prac- 
tically, the  question  becomes,  How  much  can  society  afford 
to  expend  in  an  effort  to  secure  enlightened  and  adequate 
management  of  these  affairs  of  the  community?  The  an- 
swer to  this  latter  query  will  turn  to  a  considerable  extent 
upon  the  prospective  future  of  the  individual  as  to  his  social 
relation.     If  he  is  to  be  permanently  in  custody  and  under 


MKDTriNT-:      AND      IMJHT.  ff      fl  I'.  A  F. 'fH  343 

real  snrvcill.'uicc,  l,hc  State  has  less  at  stake  in  the  develop- 
ment of  his  character  than  if  he  is  free. 

Inasmuch  as  this  factor  is  very  elastic  and  tlie  prospects 
in  any  given  case  more  or  less  indeterminable,  safety  lies 
in  the  assumption  of  possible  liberty  for  the  patient.  Upon 
that  assumption  the  State  can  ill  afford  to  spare  any  pains 
of  an  educative  and  preventive  character. 

My  conclusion  as  to  this  is  that  the  State  should  make 
an  especial  effort  to  promote  the  proper  development  of 
these  individuals  and  that  there  is  no  question  that  its 
accomplishment  is  more  possible  under  a  plan  of  special 
institutions. 

The  suggestion  preceding,  that  bad  moral  trend  is  more 
the  result  of  opportunity  and  imitation  than  innate,  gives 
the  key  to  the  discussion,  namely.  Which  plan  is  best  calcu- 
lated to  meet  the  necessities  of  society,  especially  in  respect 
to  the  limitation  and  prevention  of  defectives? 

Experience  shows  that  bad  habits,  physical  or  mental, 
are  intensely  contagious.  The  danger  from  vicious  indi- 
viduals is  by  no  means  confined  to  groups  of  the  defective. 
That  these  dangers  are  more  acute  amongst  defectives  is  no 
doubt  true.  So  far,  then,  as  concerns  limitation  of  vicious 
developments  in  those  in  custody,  there  can  be  no  doubt 
of  the  value  of  segregation. 

The  lesson,  which  is  taught  by  experience  in  schools  of 
perfectly  normal  individuals,  ought  to  be  sufficient.  Once 
a  vicious  streak  is  implanted  in  a  population,  shifting  and 
more  or  less  serial  in  its  character,  eradication  is  so  difficult 
as  to  be  almost  impossible,  except  by  absolute  separation 
of  the  old  from  the  new. 

In  conditions  where  the  authority  exists  to  transplant 
summarily  and  arbitrarily  from  one  community  to  another, 
it  ought  to  be  possible  to  limit  this  insidious  contagion. 
There  is  an  added  advantage  in  such  transfer  to  another 
institution.  To  a  considerable  extent  it  relieves  an  admin- 
istration of  the  necessit}''  for  classification  of  inmates  on  the 


344  HENRY      B  A  I  R  D     F  A  V  I  L  L 

basis  of  conduct  or  upon  a  punitive  basis.  The  less  those 
conceptions  enter  into  the  management  of  the  defective,  the 
easier  the  path  toward  mental  reconstruction. 

In  so  far  as  defectiveness  is  mere  deficiency  it  may  be 
ver>"  simple  and  essentially  of  quantitative  value,  but  per- 
version is  qualitative  and  usually  very  complex.  At  a 
glance  it  is  not  at  all  eas}'-  to  draw  this  distinction. 

Administrative  functions  are  more  and  more  being  com- 
plicated by  the  recognition  of  a  need  for  this  definition. 
Lack  of  discrimination  herein  is  so  patent  and  grievous  that 
only  the  fact  of  underlying  ignorance  can  save  placing  the 
stigma  of  "scandalous"  upon  the  situation.  The  sick,  the 
poor,  the  criminal,  the  insane,  are  all  subject  to  the  acci- 
dental grouping  instituted  by  traditional  and  prejudiced 
administration  of  social  corrections.  That  such  definitions 
in  truth  are  not  hard  and  fast,  intelligent  students  are  com- 
ing to  believe.  The  more  reason,  then,  that  the  boundaries 
be  elastic,  the  mass  mobile,  in  order  that  the  individuals 
may  be  adjusted  to  their  needs,  as  they  appear.  Accuracy 
of  definition  is  not  sharpness  or  rigidity.  It  lies  in  the 
comprehension  of  the  individual  observance  and  its  needs. 

The  important  consideration  in  this  question  is,  how  to 
escape  from  the  hitherto  almost  universal  error  of  super- 
ficial classification.  Is  a  person  vicious  because  his  act  is 
vicious?  If  so,  is  it  intrinsic  and  permanent  obliquity,  or 
is  it  amenable  to  treatment'  If  a  vicious  act  does  not 
imply  essential  viciousness,  what  factors  of  extenuation  are 
there,  and  how  are  these  to  be  interpreted  for  more  just 
classification  ? 

These  are  not  academic  questions.  They  are  proposi- 
tions that  arise  as  scientific  study  of  degeneracy,  defective- 
ness, and  delinquency  proceeds.  Interpretation  of  indi- 
viduals of  a  class  will  be  a  necessary  step  before  final 
definition  of  classes  can  be  established.  Provisional  dispo- 
sition of  abnormal  types  is  perhaps  justified  by  social 
and  economic  exigency,  but  it  is  not   the  less  provisional 


M  I-:  I)  I  (•  I  N  !•:    AND    I'  r  h  l  i  r    II  I-:  a  i,  t  ii       345 

and  iii;i(lc(|u;Llc.  vSocial  science  exists  fcjr  the  purpose  of 
replacing  jjro visional  method  with  scientific  method,  and 
the  reproach  to  civilization  will  lie  in  undue  delay  herein. 

Profound  study  of  the  normal  is  beyond  question  fun- 
damental to  social  progress.  1'horough  analysis  of  the 
pathologic  is  as  indispensable  to  social  stability.  As  in  all 
science,  the  normal  is  to  be  comprehended  through  deei> 
scrutiny  of  the  abnormal.  DifTering  from  other  science, 
experimental  pathology  cannot  be  invoked  in  social  science, 
but  abstract  pathology  and  experimental  therapeutics  be- 
come the  agencies  of  progress. 

The  world  could  w^ell  afford  to  dispense  with  its  defec- 
tives if  a  single  dispensation  would  accomplish  relief.  But 
inasmuch  as  the  stream  of  defectives  is  constantly  arising 
from  sources  not  suspected,  and  being  augmented  by  causes 
intrinsic  to  human  experience,  the  world  cannot  afford  to 
ignore  its  defectives  as  a  field  of  study  and  as  material  with 
which  to  work  tow^ard  corrective  influences.  Every  alms- 
house, every  prison,  every  insane  asylum  offers  opportunity 
for  study  so  valuable  that  it  is  almost  incredible  that  society 
has  thus  gone  on  oblivious  of  the  waste. 

That  such  institutions  are  essentially  custodial  and  de- 
cent is  far  from  being  the  tribute  to  our  advancement  that 
we  would  like  to  feel.  The  impulse  beneath  our  present 
method  is  humane,  but  in  no  sense  broadly  humanitarian. 
Association  of  study  with  relief  is  distinctive  of  modern 
sociologic  thought,  and  in  that  light  our  dependent  class 
assumes  a  new  and  crucial  importance. 

Nothing  is  more  difficult  to  teach  than  a  real  appre- 
ciation of  the  fact  that  the  value  of  thorough  and  scientific 
dealing  w4th  defectives  is  in  its  reflex  upon  society.  The 
public  view^s  with  various  degrees  of  sympathy  the  distress- 
ing results.  It  is  intensely  concerned,  for  one  reason  or 
another,  with  what  happened.  It  has  scarcely  turned  an 
ear  of  passing  interest  to  Jion'  it  happened,  and  yet  the 
latter  is  the  point  of  paramount  importance.     It  is  evident. 


346  HENRY     B  A  I  R  D     F  A  V  I  L  L 

therefore,  that  social  problems  must  find  their  solution  in 
operations  harmonious  with  the  principles  of  human  progress. 
The  principle  is  the  important  thing  to  discern.  Methods 
easily  enough  can  be  made  to  conform. 

At  this  stage,  it  seems  beyond  question  that  research 
is  the  key  to  our  present  need.  Therefore,  quite  beyond 
the  fact  of  administrative  facility  suggested  as  a  reason  for 
segregation  of  vicious  defectives,  I  urge  consideration  more 
profound. 

For  purposes  of  study  let  us  have  the  smallest  logical 
groups,  in  the  most  plastic  relation  to  the  class,  with  the 
highest  obtainable  ability  and  permanence  in  administrative 
officers. 

Upon  this  foundation  the  query  set  as  a  text  for  this 
discussion  is  definitely  answered  in  the  affirmative.  Let 
there  be  segregation  of  vicious  defectives  under  specialists. 
Let  this  be  with  a  view,  first,  to  eliminate  mental  and 
moral  contagion;  second,  to  permit  transfer,  back  and  forth, 
as  classification  becomes  accurate;  third,  to  furnish  a 
laboratory  of  specific  study,  independent  of  mass  embar- 
rassments, as  a  factor  of  real  value  to  society. 

In  no  other  way  can  the  curse  of  institutionalism  be 
avoided.  The  establishment  of  a  plastic  character  in  the 
institution  of  a  large  defective  population,  whereby  adjust- 
ment of  classification  according  to  individual  needs  becomes 
not  only  possible  but  necessary,  will  at  once  create  a  demand 
for  the  highest  intelligence  in  administration.  Under  this 
plan,  individuals  who  present  specific  characters  demanding 
interpretation  become  an  eager  quest. 

The  establishment  of  adequate  facilities  for  the  study 
and  correction  of  such  individual  tendencies  becomes  a 
logical  sequence.  The  advantage  to  society  of  effective 
dealing  with  the  individuals  in  question  must  be  beyond 
question,  but  beyond  all  this,  an  opportunity  so  afforded 
to  probe  deeply  into  the  sources  of  human  delinquency 
under  scientific  method  with  sympathetic  spirit  may  be  made 
to  yield  incalculable  help  in  the  study  of  social  problems. 


M  I-:  IM  (•  I  N  IC      AND     TMJFU.  IC      IfKAF.  TH  347 


Delivered,    N;ilion,il    Cliild     L.-ihor    AssfK-iation,    Birmingham,    Ala., 
March    10,     191 1. 

ClIIIvI)   IvAHDR  AS  REI.A'ri<:n  TD  THE  STAC^E 

IN  discussing  the  broad  topic  of  child  labor,  it  is  desirable 
to  bear  in  mind  that  we  are  dealing  with  a  matter,  the 
positive  side  of  which  is  a  matter  of  economics,  the  out- 
growth of  industrial  conditions  in  which  the  moving  factors 
have  been  to  a  large  extent  matters  of  ajjparcnt  necessity. 

On  the  negative  side  of  this  question  arc  arrayed  con- 
siderations humanitarian,  sentimental,  and  for  the  most 
part  beyond  any  question  conservative.  It  is  almost  uni- 
versally true  that  under  such  conditions  the  material  factors 
represented  in  a  system  which  has  become  fixed,  have  a 
stability  and  lack  of  elasticity  that  makes  gradual  and  care- 
fully studied  reform  extremely  difficult. 

On  the  other  hand,  it  is  true  that  propaganda  looking 
toward  abatement  of  conditions  which  are  regarded  as 
pernicious  proceed  upon  lines  of  feeling  and  denunciation 
not  always  tempered  by  calm  consideration  either  of  the 
conditions  or  of  the  circumstances  through  which  condi- 
tions have  been  evolved. 

Of  course,  this  is  tantamount  to  arguing  that  this  sub- 
ject should  be  approached  calmly,  fairly,  and  with  full 
knowledge  of  the  facts.  It  is  especially  true  of  the  child 
labor  problem  that  this  sort  of  scrutiny-  should  be  applied 
by  all  concerned. 

A  priori,  it  is  hardly  to  be  disputed  that  strenuous  labor 
is  for  children  an  undesirable  thing. 

It  is  probably  just  as  true  that  much  of  the  schooling  of 
children  who  are  not  called  upon  to  work  is  undesirable  and 
for  very  much  the  same  reasons.  Yet  to  the  school  we  are 
so  accustomed  and  to  its  undesirable  features  we  are  so  ob- 
tuse, that  there  is  hardly  a  voice  raised  in  an  aggressive  way 
looking  to  the  remedy  of  conditions  which  are  stupid  and 


348  HENRY      B  A  I  R  D     F  A  V  I  L  L 

distinctly  damaging.  The  fact,  however,  that  the  alter- 
native of  school  life  for  children  is  open  to  grievous  objec- 
tion has  absolutely  no  right  to  weight  in  discussing  child 
life  as  related  to  industrial  conditions.  Our  problem  in- 
volves no  balancing  and  disposing  of  all  social  contingencies. 
Progress  is  not  made  that  way.  The  problem  before  this 
organization  is  that  of  weighing  upon  merit  the  advantages 
and  disadvantages  in  child  labor  and  defining  as  accurately 
as  may  be  the  territories  of  safety  and  desirability.  So 
when  I  approach  this  question  of  the  effect  upon  the  physique 
of  children  of  any  pronounced  form  of  continuous  labor, 
I  shall  approach  it  without  reference  to  the  great  mass  of 
shifting  and  complicating  social  alternatives  and  upon  the 
distinct  ground  of  physiologic  values. 

There  was  a  time  when  medical  men  and  physiologists 
were  disposed  to  regard  the  problems  of  childhood  as  the 
problems  of  mature  persons  in  miniature.  It  is  not  very 
long  since  this  view  has  been  recognized  as  fallacious,  and 
we  are  hence  not  in  possession  of  abundant  data  from 
which  to  propound  unquestionable  principles  of  child  de- 
velopment. 

There  is,  however,  an  abundance  of  knowledge  at  our 
hand  to  justify  emphatic  expression  upon  many  phases  of 
this  question. 

It  is  most  valuable  in  analyzing  the  subject  to  consider 
the  notion  clearly  defined  that  youth  is  the  period  of 
growth  and  formative  activity  and  that  mature  life  is  a 
period  of  fixed  and  relatively  inactive  growth  processes. 
Immediately  arises  the  question,  How  much  more  can  a 
young  animal  be  expected  to  do  with  his  machinery  of 
nutrition  than  merely  to  grow  and  maintain  a  proper  phys- 
iologic balance?  We  know  that  in  isolated  instances  pro- 
digious feats  can  be  accomplished  by  young  animals  and 
by  young  humans,  feats  of  mind  and  feats  of  body,  but 
that  is  in  no  sense  an  answer  to  the  question.  With  human 
beings  the  question  is  not  as  to  what  the  young  can  do,  but 


M  l<:  I)  I  (•  F  N  !•:      AND      ('  T  H  I.  F  f       II  I,  A  F.  T  FI  349 

what  they  can  appropriately  do  with  respect  to  the  many 
years  of  Hfe  it  is  hoped  they  will  endure. 

Upon  that  ?)asis  it  is  safe  to  say  that  there  is  a  point  at 
which  expenditure  of  energy  through  voluntary  activities 
is  in  ideal  adjustment  to  those  ])rocesses  of  nutrition  and 
growth  which  we  consider  distinctly  vegetative.  Expendi- 
ture of  energy  beyond  this  point  means  at  the  expense  of 
proper  growth.  Effort  below  this  point  is  as  plainly  but 
perhaps  not  as  seriously  unfavorable  to  development. 

There  can  be  no  doubt  that  this  point  varies  in  different 
individuals  and  that  there  is  hence  great  difficulty  in  deter- 
mining for  children  in  masses  fixed  lines  within  which  they 
shall  all  travel. 

Educators  are  coming  to  see  this,  and  the  process  of 
differentiation  in  educational  matters  is  becoming  a  matter 
of  close  investigation.  This  applies  not  only  to  the  curricu- 
lum of  school,  but  applies  and  will  still  more  apply  to  physi- 
cal conditions  under  which  school  children  live. 

The  principle  which  is  gradually  being  evolved  in  edu- 
cational matters  is  this:  that  there  shall  be  an  elasticity  in 
school  curricula  which  shall  enable  the  various  degrees  of 
mental  and  physical  capacity  to  find  proper  measure  and 
accommodation . 

Through  it  all  runs  distinct  recognition  of  the  fact  that 
the  tendency  of  school  is  to  over-confine  and  over-restrict 
and  more  or  less  over-work  the  3'oung  child.  If  that  princi- 
ple is  sound  as  applied  to  school  life,  with  its  comparative 
latitude,  short  hours,  and  desultory  character,  why  should 
it  not  be  invoked  to  determine  what  is  proper  as  to  labor 
for  children?     The  question  admits  of  no  argument. 

As  a  human  proposition  it  is  far  more  important  that 
the  factory  be  estimated  upon  this  basis  than  that  the 
school  should  be.  As  a  practical  proposition  nobody  can 
question  that  the  effect  upon  children  of  long  hours,  rigid 
duties,  sustained  effort,  and  more  or  less  bad  hygienic  con- 
ditions which  prevail  of   necessity  in  industrial  pursuits, 


350  HENRY     BAIRD     FAVILL 

are  damaging  to  the  physical  welfare  of  the  individual  child. 
If  damaging  to  the  physical  welfare,  there  is  equally  no 
question  that  they  are  limiting  to  the  mental  development 
and  perversive  of  the  moral  development  to  a  greater  or 
less  extent. 

Let  us  grant  for  the  sake  of  extreme  fairness  that  teach- 
ing a  child  dexterity,  industry,  and  responsibility  has  a 
value.  Can  any  honest  mind  doubt  that  these  alleged 
advantages  are  more  than  offset  by  teaching  it  the  dex- 
terity of  an  automaton,  the  industry  of  a  driven  slave  and 
the  responsibility  of  a  premature  burdenbearer  ? 

These  are  matters  to  be  discussed  not  in  terms  of  scien- 
tific definition  or  of  physiologic  abstractions;  they  are  to 
be  discussed  in  the  light  of  common  sense  with  the  evi- 
dence open  to  any  honest  mind.  Let  any  adult  consider 
the  effect  upon  himself  of  prolonged,  tense,  exacting  labor, 
particularly  with  reference  to  his  reserve  supply  of  nervous 
energy,  at  the  expiration  of  his  day.  Let  him  then  ponder 
upon  the  status  of  a  child,  called  upon  for  relatively  the 
same  kind  of  expenditure,  in  the  light  of  the  fact  that  that 
child  needs  for  his  formative  processes  many  times  the 
nervous  energy  which  the  adult  needs.  The  conclusion  is 
unavoidable,  that  there  is  in  our  most  aggravated  trade 
conditions  a  relative  imposition  upon  the  child  far  greater 
than  upon  the  adult. 

The  damage  to  the  child  is  primarily  in  the  inroads  upon 
its  nervous  system,  the  robbery  of  his  vegetative  life  to 
supply  his  voluntary  activities.  The  effects  of  this  demand 
are  remote,  because  operating  through  a  long  series  of  de- 
fective nutritive  processes  which  find  their  expression  years 
hence  in  failure  of  development  on  the  one  hand,  or  exhaus- 
tion of  nervous  resources  upon  the  other.  Is  there  any 
lack  of  facts  to  substantiate  all  of  this  picture  of  demoral- 
ization ? 

The  facts  are  too  simple  of  demonstration  to  need  argu- 
ment at  this  date,  and  yet,  the  question  may  fairly  be  asked. 


M  !<:  I)  I  (■  I  N  !<:      AND      IMJ  M  L  F  r      lli-:AI,'III  351 

Are  these  evils  ('(Hh-illy  true  of  all  forms  of  chilfl  labor? 
Are  we  not  tryinjj;  to  generalize  too  broadly  and  to  do;^ma- 
tize  too  definitely  about  matters  whieh  have  strong  speeifie 
differences?  This  question  is  asked  in  many  directions  by 
those  who  see  less  clearly  than  we  the  un desirability  of 
child  exploitation. 

I  am  disi)osed  to  agree  with  those  who  argue  that  all 
fields  in  which  children  are  employed  are  not  equally  ob- 
jectionable. It  would  be  idle  to  argue  that  there  are  not 
differences  in  degree  of  undesirability  in  various  pursuits, 
and  it  is  fair  to  discuss  whether  some  of  the  employments 
of  children  have  not  enough  advantage  to  offset  the  dis- 
advantage. 

This  brings  us  to  the  immediate  subject  in  hand,  the 
question  of  employing  children  upon  the  stage.  It  is  pointed 
out  that  the  tendency  of  stage  training  for  children  is  in  the 
direction  of  education,  refinement,  and  general  elevation  of 
level;  that  of  necessity  they  are  cared  for  physically;  that 
their  usefulness  depends  upon  a  certain  degree  of  culture; 
that  their  pursuits  are  of  a  pleasure-giving  quality  as  com- 
pared with  industrial  pursuits;  and  that,  above  all,  their 
economic  usefulness  as  wage  earners  is  far  beyond  that  of 
ordinary  child  laborers. 

In  support  of  this  can  be  cited  numerous  well  known 
examples  of  people  brought  up  from  childhood  on  the  stage 
who  have  achieved  great  personal  worth  and  public  impor- 
tance. Supposing  that  all  that  is  alleged  to  be  of  advan- 
tage to  children  upon  the  stage  is  true,  does  it  carr>^  con- 
viction as  to  the  desirability  in  general  of  that  life  for  the 
young? 

It  may  hh  true  that  children  who  are  to  be  employed 
upon  the  stage  will  be  physically  somewhat  cared  for;  that 
they  will  be  comfortable  and  perhaps  live  in  relative  luxurv' 
as  compared  with  what  they  might  have  had  otherwise. 
Let  us  assume  that  it  is  so.  Does  it  imply  any  ph^'sical 
advantage  in   the   end?     Obviously   not   the  least,   unless 


352  HENRY      BAIRD      FA  V  ILL 

there  can  be  associated  with  it  definite  hygienic  Hving,  such 
as  will  offset  the  perversion  of  natural  habits  incident  to  the 
hours  of  employment  and  the  pampering  influence  of  com- 
forts which  are  devoid  of  the  elements  which  tend  to 
build  up  vigorous  bodies,  and  also  some  sort  of  mental  or 
moral  surrounding  tending  to  mitigate  the  unfailingly  de- 
teriorating effect  of  luxury,  even  such  meager  luxury  as 
could  be  implied  in  this  discussion.  I  repudiate  utterly 
the  notion  as  to  benefit  to  physique  which  is  thus  argued. 

It  is  true  that  the  children  in  question  might  have 
association  here  and  there  with  people  of  somewhat  more 
cultivated  type  than  would  be  normal  to  them;  that  the  na- 
ture of  the  calling  is  such  as  to  evoke  some  degree  of  men- 
tal response  which  on  the  whole  would  promote  intellectual 
development.  When  one  considers,  however,  that  the  cul- 
ture of  the  stage  is  on  the  whole  specious  and  superficial  and 
that  the  stimulus  that  it  affords  to  the  young  is  that  of 
excitement  and  imitation  rather  than  fundamentally  cul- 
tural, it  must  be  concluded  that  a  view  which  holds  this 
of  great  use  to  the  young  is  very  narrow. 

To  any  extent  to  which  it  affects  children  in  a  stimulat- 
ing way  at  all,  it  does  so  through  the  medium  of  highly 
strung  nervous  unnatural  appetites  and  aspirations,  false 
standards  and  faulty  methods,  which  are  calculated  to  ruin 
the  nervous  balance,  mental  poise,  and  moral  unfolding  of 
the  average  child. 

We  are  prone  to  attach  to  the  conception  of  art,  some 
mysterious,  ennobling  quality.  Is  it  true?  A  fair  survey 
of  the  field  of  art  as  it  is  recognized  to-day  will  absolutely 
dispose  of  that  contention.  Either  it  is  not  true  at  all  or 
our  conception  and  definition  of  art  has  got  to  be  radically 
corrected  and  the  field  of  art  enormously  restricted.  Hence, 
to  create  for  the  child  a  conception  of  great  privilege,  based 
upon  art  as  it  is  now  regarded,  is  to  put  forth  a  fictitious 
situation  empty  of  real  possibility  and  pregnant  with  oppor- 
tunities  for   permanent   damage.     No   discussion   of   child 


MEDIC  INK     AND     P  U  IJ  L  I  C!     H  K  A  r.  I   11  353 

culture  has  any  value  that  rloes  not  take  into  account  the 
effect  upon  character  which  the  life  experience  offers. 

Naturally,  people  differ  as  to  the  qualities  most  admir- 
able in  children,  as  they  differ  upon  qualities  most  ad- 
mirable in  men  and  women.  It  is  for  us  to  advance  and 
maintain  such  views  of  character  and  quality  as  seem  to 
us  most  sound. 

Is  there  anything  in  the  realm  of  childhood  more  dis- 
quieting than  precocious  sophistication.  Consider  it  not 
only  upon  the  side  of  premature  knowledge  and  familiarity 
with  the  undesirable  phases  of  life,  but  consider  it  in  its 
reflex  upon  the  individual  nature. 

Consider  how  possible  it  becomes  for  a  child  to  ac- 
quire that  self-consciousness  which  puts  it  into  strained 
relationships  with  nature  and  with  life;  the  certainty  with 
which  simple  and  outspoken  honesty  is  eliminated  and 
for  it  substituted  artificial  expression  and  indirect  mental 
process.  Consider  what  a  child  so  equipped  has  to  over- 
come before  there  can  develop  foundations  of  integrity  and 
morality  upon  which  every  individual  sooner  or  later  has 
got  to  build  personal  character. 

Life  is  bad  enough  as  it  is  without  offering  to  the  young 
a  double  distilled  essence  of  mental  and  emotional  poisons 
such  as  is  inevitable  here  in  the  tense  and  aggressive  work 
of  portraying  all  phases  of  human  experience  in  the  form 
of  the  drama  in  its  present  relation  to  the  public. 

There  is  great  question  as  to  how  far  the  young  should 
be  fed  with  this  material  as  an  audience;  how  enormously 
aggravated  is  the  damage  to  the  participant. 

But,  it  may  be  said,  we  are  taking  this  too  seriously. 
These  things  are  plays,  imaginary  situations,  more  or  less 
humdrum  to  those  habituated.     Let  us  see  what  that  means. 

Has  anyone  ever  gone  behind  the  scenes,  particularly 

after  being  impressed  by  good  art  upon  the  stage,  and  failed 

to  have  a  wave  of  depression  as  he  views  the  utter  lack  of 

relation  between  the  portrayals  of  the  stage  and  the  life  of 

13 


354  HENRY     BAIRD     FAVILL 

the  actors?  To  the  mature  mind,  it  is  true,  there  may  be 
■possible  accomodation  of  thought  whereby  art  and  portray- 
al may  separate  themselves  automatically  from  the  sordid 
conditions  of  stage  business,  but  take  it  by  and  large  it  may 
be  said  that  if  the  admiring  public  could  see  all  of  the  pre- 
liminaries to  the  most  magnificent  stage  success,  nothing 
but  ruin  could  attend  the  disillusionment. 

This  does  not  at  all  imply  viciousness  or  any  undesirable 
moral  quality.  It  is  a  mere  matter  of  psychology,  and  to 
those  who  are  trained  in  stage  affairs,  doubtless  rather  a 
negligible  matter,  but  to  the  young  and  impressionable  who 
are  building  up  an  experience  in  life  in  which  they  are 
acquiring  standards  as  to  life,  realities  and  values,  it  can 
not  fail  to  be  a  demoralizing  influence. 

Not  only  will  its  demoralization  show  in  doubtful  and 
uncertain  standards  but  it  will  show  concretely  in  the 
nervous  development  and  expression  of  the  individual. 
Excitement,  ambition,  emulation,  undiscriminating  fascin- 
ation, all  come  rolling  upon  a  child  in  such  a  way  as  to 
overwhelm  all  but  the  most  exceptional. 

If  what  is  at  the  end  of  the  road  were  the  most  desirable 
thing  to  attain,  this  process  of  attaining  it  would  be  too 
perilous  to  sanction  it.  In  proportion  as  that  attainment 
is  less  ideally  desirable,  the  wrong  to  childhood,  involved 
in  exploiting  it  to  this  end,  proportionately  increases.  Can 
there  be  an  advantage  from  any  point  of  view  strong  enough 
to  justify  the  sacrifice  or  the  risk? 

Those  who  are  viewing  the  welfare  of  humanity  from  the 
standpoint  of  medical  training  and  particularly  illuminated 
by  broad  medical  experience,  are  very  clear  in  their  belief 
that  progress  in  human  happiness  is  closely  related  to  health. 
The  more  we  know  of  this  subject  the  more  we  realize  that 
mental  development  and  balance  are  not  to  be  separated 
from  other  physical  questions. 

There  is  reciprocal  relation  between  bodily  states  and 
mental  states  operating  through  the  nervous  system  that 


M  IC  I)  I  (•  I  N  ]<:     AND     JMJin.IC     HEALTH  355 

makes  the  imijorlancc  of  well  developed,  carefully  pre- 
served nerve  centers  vital.  From  a  medical  point  of  view, 
no  influence  bearing  upon  the  development  of  childhood  is 
more  important  than  those  which  a  child  encounters  in 
this  period  of  nervous  growth.  From  a  scientific  or  from  a 
common  observation  standpoint,  conditions  which  tend  to 
over-stimulate,  over-fatigue,  and  generally  unstabilize  the 
nervous  system  of  children  are  destructive  for  the  most 
part,  and  if  continued  too  long,  beyond  correction. 

There  can  be  not  the  least  question  from  the  point  of 
view  of  those  who  understand  and  without  prejudice  pro- 
nounce upon  these  questions  of  child  evolution,  that  stage 
experiences  in  general  are  amongst  the  most  vicious  con- 
ditions to  which  children  can  be  exposed.  The  whole 
movement  is  without  the  slightest  justification  from  the 
standpoint  of  the  welfare  of  the  child,  and  this  fact  alone 
should  be  enough  to  stigmatize  the  effort  to  create  an  in- 
dustry for  children  upon  the  stage,  as  a  social  abomination. 


3S6  HENRY     BAIRD     FAVILL 


Delivered,  Twenty-fifth  Anniversary  of  the  Founding  of  the  Boston  In- 
structive-District Nursing  Association,  Boston,  April  25,   191 1. 
Printed,  American  Journal  of  Nursing,  October,  191 1. 

PROBLEMS   OF   VISITING   NURSES 

IT  is  a  privilege  to  come  here  and  participate  in  these 
proceedings,  really  a  very  great  privilege.  I  had  the 
temerity  to  come  here  and  serve  upon  this  program 
\\dthout  asking  anybody  what  I  was  to  say,  which  is  always 
a  risky  thing  to  do,  both  for  me  and  for  the  management. 
On  the  other  hand,  it  leaves  me  free  to  say  about  what  I 
want  to  say,  and  what  I  want  to  say  is  merely  an  epitome 
of  a  lot  of  experiences  in  which  I  have  been  involved  in  con- 
nection with  the  visiting  nurses'  work  directly  and  indi- 
rectly. I  have  never  been  able  to  feel,  and  I  do  not  feel, 
that  in  itself  it  is  a  great  misfortune  to  be  poor,  but  I  do  feel 
and  I  shall  feel  more  and  more  as  the  years  go  on,  I  know, 
that  it  is  a  very  great  misfortune  to  be  sick,  and  you  know 
and  I  know  that  with  all  the  wonderful  facilities  that  there 
are  in  the  world  for  the  amelioration  of  suffering,  they  are 
not,  up  to  this  time,  for  the  poor,  and  inasmuch  as  they  are 
not  for  the  poor,  they  are  really  not  for  the  world.  The 
inception  of  this  visiting  nursing  work  is  love,  tenderness, 
sympathy  —  there  can  be  no  doubt  about  it.  The  signifi- 
cance in  the  touch  of  these  workers  is  help,  hope,  encour- 
agement. Spiritual  uplift  is  in  the  very  initial  touch  of  the 
district  nurse. 

I  need  hardly  go  into  a  description  of  what  that  is,  since 
Dr.  Worcester  has  pointed  out  to  you  what  the  district 
nurse  does,  in  her  indescribably  irregular  routine.  She 
meets  the  situation  as  she  finds  it,  goes  into  a  house  and 
finds  it  squalid,  dirty,  careless,  ignorant,  and  hopeless,  and 
instantly  measures  her  forces.  In  five  minutes  there  is 
not  an  individual  in  this  house  who  is  able  to  do  something 
that  is  not  doing  something.     The  house  is  cleaned,  the  bed 


MEDIC  IN  10      AND      IM:i{|,fr      III,  A  I.  I   II  ',57 

is  chanj^ed,  Ihc  ]).'ili('nl  is  .-lUcndcd  1,0.  The  plafce  is  at  once 
organized  and  llic  psycholoj^y  of  the  change  in  the  sick  room 
is  beyond  description.  The  result  of  all  this,  of  course,  is 
enormous  comfort,  but  the  result  is  more  than  that,  and  to 
this  I  call  your  attention  with  the  utmost  seriousness  as 
bearing  upon  any  class-of  people, — the  result  is  an  increased 
self-respect.  This  is  no  pauperizing  process.  This  is  not 
making  people  feel  dependent  and  more  or  less  disgraced. 
It  is  essentially,  fundamentally,  and  most  unquestionably 
a  contact  whereby  self-respect  is  markedly  increased. 

You  see  from  this  that  one  conclusion  is  to  be  reached, 
and  that  is  that  the  work  of  the  district  nurse,  important 
as  it  may  be  as  a  physical  factor,  is  more  a  mental  and  moral 
influence,  and  like  everything  mental  and  moral  in  life,  of 
paramount  importance.  This  the  district  nurse  does,  almost 
without  knowing  it,  but  she  does  it.  It  is  a  great  educative 
matter.  She  no  sooner  gets  involved  with  her  work,  with 
various  classes  of  her  work,  than  she  finds  she  is  established 
on  relations  of  great  intimacy.  The  next  thing  she  comes 
in  contact  with  is  the  school,  through  the  children  in  the 
house,  and  immediately  takes  up  and  establishes  relationship 
therewith.  Then  she  finds  herself  connected  with  the  indus- 
trial situation,  closely  related  to  the  factor}',  shops,  what- 
ever it  may  be  in  which  her  group  may  be  interested.  It 
becomes  inevitably  so,  whether  she  wants  it  or  not,  and  the 
result  is  that  she  finds  herself  at  once  a  factor  in  the  social 
situation  which  is  unique.  Having  done  this,  having  worked 
along  in  the  course  of  her  contribution  to  this  situation,  she 
finds  herself  a  very  important  person.  No  district  nurse 
who  fully  realizes  the  breadth  of  her  field  can  fail  to  feel  an 
importance  to  her  duty,  to  her  work,  that  prevents  her  from 
being  anything  but  serious  and  responsible.  In  the  first 
place,  she  acquires,  above  all  people  in  the  community  per- 
haps, insight;  she  acquires  an  understanding  of  how  those 
people  think  and  feel  and  live.  This  is  of  the  utmost  impor- 
tance when  you  consider  the  fact  that  she  also,  by  reason 


358  HENRY     BAIRD     FA  V  ILL 

of  her  relationship  to  the  organization  in  question,  has 
access  not  onl}^  to  the  people  whom  she  is  nursing,  but  to 
the  people  who  are  so  far  outside  of  that  world  that  they 
have  neither  comprehension,  nor  any  possibility  of  compre- 
hending without  some  such  assistance,  the  way  those  people 
think  and  feel  and  live.  And,  from  the  fact  that  she  has 
insight,  and  has  access  to  both  levels  in  the  social  structure, 
and  moreover  has  the  unbounded,  undoubted  confidence 
of  both  parties  to  this  operation,  there  comes  upon  the  dis- 
trict nurse  individually  and  collectively  an  obligation  in 
the  social  fabric  that  is  second  to  none  —  I  make  no  res- 
ervation in  my  own  mind. 

And  that  constitutes  the  first  stage  of  the  visiting  nurse 
development  —  the  development  of  usefulness,  the  develop- 
ment of  powers  and  responsibilities.  As  soon  as  that  height 
has  been  reached,  the  organization  or  the  individual,  as  the 
case  may  be,  reaches  another  point.  They  find  it  necessary 
to  take  their  bearings.  The  thing  is  becoming  too  big, 
perhaps.  It  is  reaching  out.  What  are  we  going  to  do? 
What  is  our  status  in  the  community?  We  have  received 
a  recognition.  We  as  visiting  nurses  are  authorities  in 
our  localities.  We  are  distinctly  clothed  with  authority  of 
various  kinds,  and  people  are  looking  to  us  for  guidance, 
for  instruction,  for  protection  in  various  ways,  and  as  a  local 
factor  the  district  nurse  becomes,  to  a  degree  that,  unless 
you  know  about  it,  you  would  never  believe,  a  factor  and  a 
monitor  in  the  community  in  which  she  is  operating. 

Again,  she  is  expected  to  have,  and  she  gradually  does 
have,  as  she  must  have,  vision.  She  must  be  able  to  see 
not  only  into  the  hearts  of  her  people,  but  into  the  future, 
into  the  community,  into  all  the  weave  of  the  fabric  of 
society  which  is  going  to  bear  upon  her  proposition.  And 
all  this  is  accorded  her  without  a  word  by  her  people,  depend- 
ents and  colleagues.  That  is  her  recognition,  and  just  the 
minute  she  is  recognized  in  that  way  there  comes  in  all 
this  variety  of  functions  which  we  are  struggling  with  as 


M  i<;  I)  I  (•  I  N  i<:    A  N  r)    p  u  i{  i,  i  c    ii  i<:  a  \,  v  w       t,^() 

practical  problems.  vShe  is  wanted  as  a  sick  nurse;  she  is 
wanted  as  an  insurance  nurse;  she  is  wanted  in  connection 
with  the  Associated  Charities;  or  she  is  wanted  in  a  number 
of  different  capacities  because  of  her  essential  adaptability 
to  the  situation. 

And  so  comes  along  in  this  whole  visiting-nurse  problem 
the  great  question  of  expan.sion.  It  is  inevitable;  it  must 
come,  and  what  can  be  done  about  it?  It  is  a  silent  unob- 
trusive process  at  first.  It  is  another  nurse  here,  another 
nurse  there,  and  finally  we  have  doubled  our  quota.  After 
that  it  becomes  an  expansion  in  functions  rather  than  in 
numbers,  and  we  find  this  function  is  taken  up  —  the  school 
nurse,  the  insurance  nurse,  the  industrial  nurse,  whatever 
it  may  be.  But  finally,  when  we  have  got  to  that  point, 
we  have  reached  practically  an  impasse,  and  this  has  hap- 
pened to  every  organization  in  some  form.  The  point  has 
been  reached  where  the  structure  is  greater  than  the  found- 
ation, where  the  foundations  have  got  to  be  broadened  in 
order  to  insure  the  stability  of  the  superstructure. 

And  so  we  come  right  up  to  the  point  that  you  are  at 
here,  that  we  are  at  in  Chicago,  which  they  come  to  in  any 
place  I  know  of,  the  question  of  the  orderly  reconsideration 
of  the  whole  problem  to  determine  what  is  the  course  to 
pursue.  Shall  it  be  a  course  of  expansion,  or  shall  it  be  a 
course  of  contraction?  It  has  practically  got  to  be  one 
or  the  other.  Shall  it  be  that  we  follow  the  legitimate 
evolution  of  this  medico-sociologic  thing,  or  shall  we  set 
arbitrary  definitions  to  which  it  shall  be  confined?  And 
this  is  a  question  which  faces  us  as  a  ver^^  important 
question,  because  no  work  which  has  in  it  the  inherent 
values  that  are  in  this  system  of  visiting  nursing  has  any 
excuse  for  being  jeopardized  by  mistakes,  and  the  obligation 
to  settle  this  question  wisely  and  broadly  is  enormous. 

So  w^e  come  sooner  or  later  to  the  question  of  establish- 
ment of  values;  and  what  are  the  values  in  this  situation? 
I  shall  not  take  your  time  to  go  into  it  very  deeply,  but  let 


36o  HENRY     BAIRD     FA  V  ILL 

US  start  with  the  beginning,  the  idea  of  service  to  the  poor. 
Let  me  ask  you,  "Who  are  the  poor?"  Do  you  reaHze 
that  with  the  vast  majority  of  people  in  the  world,  the 
line  between  independence  and  dependence  is  drawn  sharply 
and  definitely  at  the  day's  work?  Do  you  realize  that  the 
absolute  value  of  physical  vigor  of  the  worker  in  a  family 
is  the  determining  factor  in  his  status  as  between  dependence 
and  independence?  That  is  a  very  close  margin  in  prac- 
tice, but  it  is  an  exceedingly  uncomfortable  fact  to  live  with. 
It  is  a  ver3^  serious  matter,  as  anyone  who  has  had  any 
financial  difficulties  anywhere  knows,  that  the  status  of 
yourself  and  children  is  determined  by  as  narrow  a  margin 
as  your  ability  to  go  to  work  to-morrow.  And  yet  that  is 
the  fact  that  obtains  with  most  of  the  world.  Therefore 
the  question,  "Who  are  the  poor?"  becomes  essentially  a 
relative  question.  The  question  becomes,  not  "Who  are 
the  poor?"  but  "Who  are  the  well?"  That  is  the  question 
in  the  world,  and  when  you  come  to  put  it  that  way  you 
see  that  the  function  and  scope  of  charity,  philanthropy, 
or  social  service,  whatever  you  call  it,  in  this  direction,  is 
liable  to  be  multiplied  way  beyond  anything  that  you  may 
anticipate,  because  the  territory  extends  far  beyond  any 
mere  hypothesis  or  conception  of  pauperism.  It  has  noth- 
ing to  do  with  pauperism.  It  is  essentially  an  industrial 
question.  Hence,  this  service,  primarily  for  those  who  are 
temporarily  dependent  —  and  that  is  the  term  I  prefer, 
rather  than  "the  poor"— this  service  for  the  temporarily 
dependent  is  the  greatest  boon  that  is  conferred  by  this  kind 
of  an  organization.  And  yet  it  by  no  means  defines  the 
Hmits  of  values  in  this  work.  The  community  is  essentially 
and  fundamentally  interested  in  this  question ;  it  has  some- 
thing at  stake.  The  community,  for  example,  can  not 
afford  to  have  a  case  of  tuberculosis  in  existence  one  minute 
longer  than  is  necessary.  The  incipiency  of  disease  is  the 
key-note  of  the  handhng  of  that  situation  and  of  a  mul- 
titude of  others.  The  relation  of  visiting  district  nursing 
of  some  sort  to  that  question  of  incipiency  is  vital. 


M  I-:  I)  I  (■  I  N  F<:      AND      I'll'.  I.  If:      HFCALTFI  361 

Then  comes  the  (|uestion  of  limitation  of  the  spread  of 
disease.  The  community  cannot  afford  to  have  one  more 
case  of  typhoid  fever  in  proj^ress  than  is  absolutely  neces- 
sary, and  whether  typhoid  fever  will  spread  through  an 
entire  family  or  not  is  li.-ihlc  to  l)c  determined  absolutely 
and  solely  by  the  district  nurse,  and  the  community  has 
not  the  slightest  justification  in  not  furnishing  that  nurse 
in  that  situation,  to  avoid  the  risk  of  any  such  thing. 

Moreover,  the  great  problem  of  the  administration  of 
charity  or  philanthropic  contribution  of  any  sort  is  the 
problem  of  money.  Experience  has  shown  that  the  most 
economical  use  of  money  that  can  be  made  in  connection 
with  the  care  of  the  sick  is  that  which  can  be  done  through 
an  adequate  service  of  district  nursing,  and  therefore  the 
community  is  again  involved  in  this  query,  Who  pays  the 
bill  of  all  the  sickness  in  the  community  finally  ?  The  com- 
munity. You  may  not  see  it,  you  may  not  feel  it,  you  may 
not  know  where  it  goes,  but  the  community  pays  the  bill; 
and  the  community  is  consequently  concerned  in  this  ques- 
tion of  conditions,  the  things  that  create  conditions,  and  the 
things  that  modify  conditions.  The  information  and  the 
energy  necessary  to  deal  with  the  situation  is  possible  of 
development  under  a  sufficiently  comprehensive  scheme  of 
district  nursing. 

So  we  find  that  the  district  nursing  possibilities,  in  the 
combination  of  nursing  functions  and  sociologic  situations, 
are  almost  unlimited.  We  find  another  thing — ^they  are 
not  quite  fit  to  stand  alone.  District  nursing  can  not  be  a 
success  in  all  its  particulars  except  it  be  associated  in  some 
way  with  a  wise  contribution  of  medical  knowledge.  It 
brings  before  us  definitely  the  question,  which  is  a  very  deli- 
cate question  from  a  physician's  standpoint:  Are  the  re- 
sources of  medicine  known  to  the  world  available  generally 
for  the  common  good?  And  the  answer  to  that  question  is 
unequivocally.  No,  they  are  not.  The  availability  of  med- 
ical knowledge  for  the  mass  of  people  is  pitifully,  pain- 
fully—  I  don't  know  but  I  may  say  culpably  —  meagre,  and 


362  HENRY     BAIRD     FAVILL 

the  question  is :  What  are  we  going  to  do  about  it  ?  I  want 
to  say  that  I  believe  the  medical  profession,  the  whole  medi- 
cal "business,"  is  bound  to  undergo  a  radical  transformation. 
I  can  not  now  stop  to  develop  what  seems  to  me  the  future 
of  medical  practice,  but  I  do  want  to  say  that  any  solution 
of  this  question  which  does  not  bring  into  availability,  prac- 
tically, all  of  the  possibilities  known  to  medicine  for  every- 
body, is  a  dead  failure  and  not  in  any  sense  a  solution.  Now 
the  question  often  is:  Is  it  just,  is  it  right,  that  the  poor  shall 
be  able  to  exact  from  the  world  a  degree  of  medical  comfort 
or  benefit  or  skill,  or  whatever  you  choose,  when  they  can 
not  get  the  same  relative  benefits  in  any  other  direction? 
I  answer,  that  it  is  my  conviction  absolutely  that  they  are 
so  entitled,  and  I  believe  the  future  will  show  that  the  health 
of  the  people  will  stand  in  relation  to  the  public  contribu- 
tion, whether  it  be  official  or  unofficial,  in  an  entirely  differ- 
ent light  from  most  other  benefits.  Shall  we  regard  health 
like  groceries  or  clothes?  In  my  judgment,  it  is  not  going  to 
be  so.  Health  is  going  to  stand  by  itself  as  regards  its  avail- 
ability, and  I  am  clear  in  my  opinion  that  we  shall  see  the 
time  when  nobody  is  so  poor  but  that  the  best  of  medical 
resources  can  be  secured  for  him.  Necessarily,  for  a  great 
while  that  is  going  to  be  a  more  or  less  feeble,  perhaps  half- 
hearted, process;  nevertheless,  that  thing  is  going  on,  and 
while  it  is  in  a  state  of  imperfection,  in  a  state  of  develop- 
ment, both  of  facilities  and  conception,  there  is  one  way 
that  the  medical  profession  can  make  progress  with  reference 
to  enlarging  its  field  of  activities,  and  that  is  through  the 
cooperation  of  a  trained  body  of  nurses  which  shall  be  an 
intermediary  between  its  knowledge  and  the  application  of 
it  in  various  directions.  As  I  look  at  this  matter  of  the 
development  of  the  medical  system  of  the  world,  as  I  look 
upon  this  question  of  public  health  in  all  its  future  aspects, 
I  come  to  the  conclusion  that  the  combination  of  medical 
scientists  and  trained  women  nurses  is  indispensable.  This  is 
not  said  in  reproach  of  the  medical  profession,  it  is  simply  said 
in  forecast  of  what  the  medical  profession  will  see  for  itself. 


M  JO  I)  I  (    I  N  !<:      AN  I)      I'  i;  H  L  I  C     II  E  A  f.  T  H  363 

I  now  come  to  one  ciuestion  which  is  very  important  — 
I  have  only  n  minute  to  talk  about  it  —and  this  is  the 
question  of  specialization  among  nurses.  The  tendency  is 
to  divert  nurses'  energies  into  this  direction  or  that,  that 
really  leads  them  into  a  field  of  specialties,  and  I  believe  it 
is  necessary.  I  believe  the  general  nurse,  in  making  her 
visiting  rounds,  is  not  the  best  nurse  to  be  a  tuberculosis 
nurse  in  a  certain  class  of  tuberculosis  cases,  particularly 
incipient  cases  that  are  the  educative  cases.  I  believe  the 
general  nurse,  engrossed  in  her  work,  is  not  the  best  nurse 
to  deal  with  the  question  of  infant  feeding.  Why  do  I  be- 
lieve these  things,  for  I  did  not  always  believe  them?  I 
believe  them  for  two  or  three  reasons.  In  the  first  place, 
because  there  is  too  much  to  do,  and  division  of  labor  be- 
comes a  necessity.  In  the  second  place,  there  are  very  few 
of  us  that  have  the  kind  of  minds  that  will  reach  out  and 
grasp  all  sorts  of  questions.  It  is  a  great  deal  easier  to  train 
us  to  do  well  —  perfectly,  if  you  like  —  a  thing  or  a  few  things, 
than  it  is  to  give  a  full  grasp  of  all  sorts  of  problems.  Con- 
sidering that  our  supply  of  nurses  is  limited,  that  we  cannot 
reach  out  for  the  exceptional  women  in  all  directions  and 
bring  them  in,  but  that  we  must  take  the  supply  as  we  find 
it,  we  have  got  to  adapt  our  work  to  the  particular  capacit- 
ies of  those  people,  and  some  nurses  are  better  in  one  line, 
and  some  are  better  in  another.  Hence,  in  my  judgment, 
specialization  is  the  thing  of  the  future.  Moreover,  the  work 
will  be  better  done  by  the  specialist  among  nurses  than  by 
those  who  undertake  to  do  the  whole  thing  at  one  time. 

Now  I  know  what  you  are  thinking  about  in  regard  to 
that.  Those  who  have  had  experience  in  this  matter  are 
prone  to  say  that  specialization  leads  to  duplication,  leads  to 
two  or  three  nurses  doing  the  same  thing,  going  to  the  same 
house.  I  agree  with  part  of  that  statement,  and  not  with  the 
other  part;  it  does  lead  to  two  or  three  nurses  going  to 
the  same  house,  but  it  does  not  necessarily  lead  to  their  doing 
the  same  thing,  and  I  want  to  call  your  attention  to  the  dis- 
tinction between  duplication  which  is  merely  geographic  and 


364  HENRY     B  A  I  R  D     F  A  V  I  L  L 

duplication  of  function.  It  does  lead  to  several  nurses  going 
to  the  same  house  sometimes,  which  means  the  question  of 
care,  but  it  does  not  mean  the  question  of  duties,  and  that 
is  the  crux  of  the  whole  matter.  So  there  may  properly 
be  one  nurse  taking  care  of  the  case  of  rheumatism,  and 
another  visiting  and  patiently  teaching  the  case  of  incipient 
tuberculosis,  and  another  instructing  the  mother  in  feeding 
her  infant.  That  this  may  lapse  into  an  indefensible  dupli- 
cation must  be  recognized.  Where  are  the  safeguards 
against  this?  How  are  we  going  to  keep  from  falling  into 
this  pitfall?  The  safeguards  are  two,  both  of  which  are 
deeply  developed  in  this  community.  The  first  safeguard 
is  organization,  such  central  organization  as  will  have  a 
general  oversight  over  the  function  rather  than  merely 
over  the  distribution  of  nurses  of  all  kinds.  And  in  the 
second  place  —  and  I  want  to  say  to  you  that  this  is  far  and 
away  the  most  important  factor  in  the  situation  —  the 
second  safeguard  against  clash  among  these  various  classes 
of  nurses  is  spirit,  the  spirit  of  cooperation  as  against  the 
spirit  of  conflict  of  any  sort.  It  is  the  most  difficult  thing 
absolutely  to  secure;  it  is  the  most  potent  thing  in  the 
situation,  once  it  is  secured. 

You  will  see,  consequently,  after  this  very  superficial 
touching  on  some  of  the  phases  of  this  subject,  that  I  at  least 
have  basis  for  feeling  in  the  matter,  and  that  I  at  least  see 
what  the  problem  is  in  some  of  its  phases  in  the  working 
out.  There  is  just  a  word  that  I  want  to  say  in  conclusion. 
Be  not  afraid  of  a  conception  of  this  institution  that  is  big 
enough  to  fill  the  bill;  be  not  afraid  of  the  social  worker  or 
the  specialist,  or  of  any  of  the  innovations  that  come  out  of 
this.  Look  to  the  regeneration  of  the  medical  profession 
as  the  greatest  possible  additional  force  and  value  in  the 
work.  Feel  that  the  development  of  the  future  is  not  to  be 
determined  by  the  perplexities  of  the  present.  In  order  to 
be  in  the  front  of  the  work  in  the  future  it  is  vital  to  have 
had  a  large  enough  concept. 


M  !•:  I)  I  (■  I  N  1<:      A  N  F)      IMHI,  ir      fri:Af,TF[         365 


Dale  and  occasion  of  writin;^  nnknovvn. 

THE    IMPORTANCE   OF   THE   VISITING   NURSE 

THE  work  of  the;  visiting  nurses  is  a  serious  business. 
Started  originally  as  a  measure  of  tenderness  and 
sympathy,  it  grows  as  a  rule  into  an  institution, 
large,  complex,  and  markedly  inter-related  to  public  ques- 
tions which  increase  its  importance  and  responsibilities  enor- 
mously. In  its  inception  it  satisfies  a  sentiment  of  philan- 
thropy quite  justifiable.  In  the  course  of  its  growth  it 
tends  to  create  conditions  which  can  only  be  adequately 
met  by  wise  and  comprehensive  organization. 

In  the  course  of  every  such  development  there  come 
periods  at  which  the  thoughtful  inevitably  pause  to  take 
their  bearings.  Valuable  service  brings  recognition  and 
recognition  brings  greater  opportunity,  and  that  in  turn  a 
demand  for  extension. 

There  comes  a  time  in  this  process  when  the  structure 
is  out  of  proportion  to  the  foundation,  and  at  this  point 
the  only  method  of  dealing  is  that  which  applies  to  all 
serious  business.  The  time  arrives  in  any  community  en- 
gaged in  this  business  to  take  stock,  to  review^  the  value  of 
present  activities,  facilities  at  hand,  desirable  projects  and 
possible  development  of  organization.  No  work  of  this 
importance  is  justified  in  proceeding  without  this  orderly 
reconsideration  of  the  whole  matter. 

Primaril}^  is  the  w'ork  involved  worth  doing?  There 
can  be  no  question  about  it.  This  is  not  a  w'ork  designed 
only  for  the  poor.  It  is  designed  to  meet  this  fundamental, 
not  well  recognized  fact;  the  line  between  independence 
and  dependence  is  drawn  definitel}^  and  sharply  at  the  point 
of  physical  vigor.  Most  people  in  the  world  are  poor  at 
the  point  of  sickness. 

The  sentimental  value  to  the  community  of  being  able 
to  extend  succor  at  this  juncture  is  immxcasurable.     These 


366  HENRY     BAIRD     FA  V  ILL 

facts,  however,  develop  immediately  a  further  situation. 
It  becomes  to  the  community  a  matter  of  imperative  eco- 
nomic importance.  Conditions  pertaining  to  the  majority 
of  the  community  which  determine  the  status  of  depend- 
ence and  independence  are  of  paramount  importance.  In- 
fluences which  affect  those  conditions  favorably  or  unfavor- 
ably are  matters  of  serious  consideration.  No  social  force 
at  work  is  more  crucially  related  to  this  matter  than  the 
work  of  the  visiting  nurses.  It  hence  becomes  to  the 
community  a  vital  interest. 

Neither  the  philanthropic  nor  economic  considerations 
here  referred  to  are  entirely  met  by  merely  skillful  nursing. 
The  matter  of  medical  contribution  to  this  situation  is  also 
vital.  Let  us  put  this  simple  question, — Are  the  present 
resources  of  medical  science  available  for  the  benefit  of  the 
public?  The  answer  is,  unequivocally,  no.  With  all  our 
machinery,  philanthropic  organization  and  personal  de- 
votion, the  distribution  of  medical  values  in  the  world  is 
pitifully  meager. 

The  medical  profession  is  on  the  eve  of  radical  trans- 
formation in  its  relation  to  the  public  weal.  The  detail  of 
this  it  is  not  necessary  to  relate. .  Suffice  it  to  say  that  medi- 
cal contribution  practically  can  not  be  made  except  through 
the  cooperation  of  a  trained  intermediary  body.  If  the 
physicians  at  large  are  going  to  justify  the  demand  which 
ethically  can  be  made  upon  them,  there  must  be  established 
and  maintained  a  cooperating  machinery  which  shall  effec- 
tively apply  the  knowledge  available  for  this  purpose. 

The  highest  possible  development  of  trained  nurses 
under  the  organization  we  are  discussing  will  be  necessary 
in  order  to  perfect  this  project. 

Of  these  three  considerations,  ministration  to  the  suffer- 
ing, self-preservation  of  the  community,  or  salvation  of 
the  medical  profession,  it  would  perhaps  be  difficult  to 
designate  the  most  important.  The  fact  is  clear,  however, 
that  they  are  inseparably  related  and  that  no  manner  of 
dealing  with  this  visiting  nurses  proposition  that  does  not 
encompass  the  entire  scheme  will  be  either  adequate  or 
defensible. 


MEDICINE      AND     TMJ  P,  E  T  f      H  E  A  E  T  fl         .^67 


Delivered,  National  Eflucation  Association,  1913. 

Printed,  Proceedings  of  the  National  Education  Association,  July,  1913. 

RURAL   HYCxTRNE 

IN  considering  hygiene,  rural  or  urban,  we  are  prone  to 
forget  the  simpHcity  of  its  principles  in  an  endeavor  to 
meet  the  complexities  of  its  application.     One  law  un- 
derlies the  hygiene  of  all  life,  and  it  is   as   inf9.11ible  and 
fundamental  and  determining  for  plants  and  animals  as  for 
human  beings. 

The  processes  of  life  depend  upon  adequate  appropri- 
ation of  food  and  innocuous  disposal  of  waste.  These 
terms  are  to  be  interpreted  broadly,  to  cover  air  and  water, 
but  with  this  inclusion  the  principle  is  complete.  Two 
sub-principles  are  universal:  (i)  regard  for  the  interests  of 
coexisting  life,  be  they  reciprocal  or  antagonistic;  (2) 
adaptation  to  conditions  of  physical  environment.  Out 
of  interaction  of  these  principles  must  be  evolved  all  hy- 
gienic and  sanitary  law.  Waiving  for  the  moment  ques- 
tions of  access  to  food  and  mutual  protection,  the  problem 
of  individual  safety  from  a  hygienic  standpoint  is  difficult 
in  direct  ratio  to  the  multiplication,  which  involves  prox- 
imity, of  other  individuals.  Community  life,  evolved 
primarily  as  a  measure  of  safety  and  economic  facility, 
becomes  rapidly  and  effectively  a  menace  to  its  individual 
components.  With  every  refinement  of  civilization  has 
come  deeper  disturbance  of  primitive  law  of  supply  and 
demand.  It  is  more  than  a  jest  —  the  recipe  for  rabbit  pie. 
One  might  starve,  but  he  never  would  be  overfed  if  he  had 
first  to  catch  his  hare.  It  is  just  as  certain  that  those  would 
starve  or  freeze  or  be  devoured  w^ho  are  unable  to  provide 
for  themselves;  and  this  is  nature's  inexorable  law.  We 
have  substituted  for  natural  selection  social  devices,  and 
we  are  slowly  coming  to  realize  the  penalties  involved,  and 
to  feel  an  obligation  to  meet  the  exigencies.     For  the  checks 


368  HENRY     BAIRD     FAVILL 

and  balances  of  limited  food  and  shelter,  and  instinctive 
guidance  in  their  use,  we  have  substituted  relative  ease 
and  plenty,  and  adopted  an  imitative  method  which  results 
in  custom"  and  habits. 

There  is  but  one  method  worthy  of  acceptance  in  social 
development:  to  prove  all  things.  In  the  proving  it  be- 
comes obvious  that  development  of  custom  has  followed 
lines  dependent  on  the  possession  of  material  resources,  in 
part,  and  only  in  part,  heeding  the  principle  of  appropriate 
use  of  food  and  adequate  disposal  of  waste. 

Let  us  pause  to  reflect  that  waste  is  not  only  the  obvious 
matter  of  excreta,  in  which  the  community  is  especially 
interested  as  against  the  individual,  but  it  is  also  the  fine 
chemical  question  of  cellular  waste  and  its  disposal,  in  which 
the  individual  is  interested  as  against  himself.  It  is  doubt- 
less in  respect  to  this  proper  balance  in  bodily  processes, 
which  one  may  venture  to  call  physiologic  cleanliness,  that 
the  most  profound  hygienic  laws  may  in  the  end  be  deter- 
mined. 

The  question  for  us  is:  Do  we  care  to  adopt  extraor- 
dinary means  to  protect  ourselves,  or  shall  we  let  nature 
operate  unmodified?  Thus  far  we  have  seen  fit  to  modify 
the  operations  of  nature  widely.  Why  not  in  this  most 
vital  struggle?  The  logic  of  this  is  too  plain  to  justify 
argument,  and  yet  we  are,  as  public-spirited  citizens,  in  the 
throes  of  a  struggle  to  institute  and  maintain  simple  pre- 
cautions against  the  dangers  of  community  life. 

It  is  true  that  the  measures  suggested  have  not  always 
been  wise,  and  that  opposition  to  a  plan  has  often  sub- 
merged a  principle.  It  is  true  that  conception  of  the  princi- 
ple has  been  defective,  and  methods,  by  reason  of  their 
provisional  character  and  tentative  scope,  have  not  reached 
the  root  of  matters.  Nevertheless,  there  is  but  one  ground 
upon  which  civilized  people  can  stand, —  the  paramount 
necessity  and  obligation  to  provide  conditions  for  all,  which 
are  wholesome  and  which  permit  the  observance  of  hygienic 


M  K  I)  I  (•  I  N  i:      AND      F'  n  15  [.  f  C      fl  !•;  A  F.  T  FI  369 

law.  I  ask  you  to  ohscrvc  the;  statement:  "wholesome 
conditions  that  will  ijcrmit  hyj^ienic  living."  Wholesome 
conditions  demand  sanitary  law;  hygienic  living  demands 
intelligent  habits.  Sanitary  law  without  personal  hygiene 
is  vastly  limited  in  its  beneficence.  Correct  habit  in  un- 
sanitary conditions  is  more  or  less  futile. 

Both  lines  of  this  development  must  be  advanced. 
Unfortunately,  they  do  not,  as  a  rule,  proceed  pari  passu. 
Sanitary  law  involves  but  the  intelligent  action  of  legis- 
lators. It  is  prompt  and  effective.  Hygienic  living,  on 
the  other  hand,  involves  substitution  of  habits  for  other 
habits  —  in  the  mass,  a  colossal  undertaking.  Logically, 
one  might  believe  that  when  a  people,  by  and  large,  had 
correct  ideals  and  corresponding  habits  of  life,  sanitary  law 
would  be  unnecessary,  or  easy  and  inevitable  of  achieve- 
ment. Doubtless  this  is  true,  but  need  we  postpone  for  an 
event  almost  millennial  the  benefits  of  common  observances 
which  never  will  be  superfluous,  and  which  protect  a  large 
portion  of  the  territory  we  are  striving  to  redeem? 

In  comparison  with  the  problems  presented  by  city  con- 
ditions, rural  sanitation  has  few  inherent  difficulties.  From 
the  standpoint  of  public  administration,  a  coefficient  of 
difficulty  could  be  adduced  for  all  communities  based  on 
the  number  of  inhabitants  per  acre.  Upon  this  basis 
country  sanitation  becomes  simple,  though  not  so  trifling 
in  view  of  the  fact  that  animals  must  be  included  in  this 
calculation. 

Why,  then,  is  sanitary  progress  in  rural  districts  not 
markedly  in  advance  of  other  communities?  Admittedly 
it  is  not.  In  many  directions  it  is  far  behind.  Two  facts 
in  explanation  of  this  are  pertinent.  The  simplicity  of  a 
problem  bears  no  relation  to  its  early  solution;  besides, 
rural  advance  is  unduly  tard}^  Moreover,  the  deepest 
reforms  arise  out  of  conditions  the  most  aggravated.  The 
countr^^  has  not  these.  The  natural  evolution  of  sanitarv' 
standards   is   here   not    to   be    trusted.     For    this    reason 


370  HENRY     BAIRD     FAVILL 

Specifically  and  intensely  directed  attention  is  indispensable 
in  most  districts. 

When  one  affirms  the  simplicity  of  country  sanitation 
from  the"  general  administrative  side,  or  the  possible  habi- 
tation side,  he  must  not  ignore  certain  specific  difficulties 
that  are  on  the  social  and  industrial  side.  Isolation  implies 
relative  safety  from  contagion,  both  to  the  individual  and 
to  the  community;  but  it  carries  with  it  complex  industrial 
function  and  freedom  from  scrutiny.  These  two  factors 
are  of  paramount  importance  in  the  present  status. 

Let  us  illustrate.  The  farmer  has  a  small  dairy.  He 
and  his  wife  and  children  milk  as  a  regular  duty.  A  case  of 
typhoid  fever  occurs  in  the  house.  The  wife  is  nurse  and 
milker.  The  father  is  milker  and  distributor  of  milk  in  some 
fashion.  The  children  are  variously  either.  Compared  to 
the  process  of  walling  off  a  case  of  typhoid  in  the  city,  con- 
sider the  complexity  of  this  farm  situation.  The  patient 
must  be  nursed;  there  is  no  one  but  the  mother  to  do  it. 
The  cows  must  be  milked  —  she  must  do  her  share.  The 
milk  must  be  disposed  of  —  shall  it  be  thrown  away? 
There's  the  rub.  With  no  one  to  know  what  goes  on,  why 
waste  it  ?  Or,  if  thrown  away,  what  a  relatively  deep  inroad 
into  the  family  income.  All  the  work  to  do,  all  the  expense, 
and  no  return.  Is  it  any  wonder  that  farmers  are  not 
looking  for  sanitary  restriction  ?  Yet  this  is  inherent  in  the 
complex  function  of  a  farmer's  life. 

This  is  no  reason  why  the  question  should  not  be  met 
and  dealt  with  thoroughly.  But  it  is  one  of  many  illus- 
trations which  should  lead  to  the  conclusion  that  rural 
sanitation  should  not  be  directed  from  the  viewpoint  of 
the  city,  but  by  careful  study  and  provision  for  its  specific 
necessities.  Supervisory  control  of  sparsely  settled  dis- 
tricts is  not  feasible.  By  as  much  as  the  individual  is  a 
relatively  free  agent,  by  so  much  is  his  reliability  depend- 
ent on  his  integrity  of  purpose.  The  very  conditions  that 
make  rural   sanitation   feasible   determine  the  lines  upon 


ME  1)1  CI  NIC      AND      IMM'.  L  I  r'      11  i;  A  F.  T  FI  371 

which  ifmust,  ^o.  Hero  the  emphasis  must  be  placed  upon 
individual  responsibility.  By  no  other  idea  can  it  ade- 
quately be  met.  This  does  not  mean  that  the  principle 
is  different  in  the  two  cases.  It  does  mean  that  relatively 
perfect  sanitation  is  possil)k'  in  the  country. 

While  I  have  no  reservation  as  to  the  importance  of 
developing  sanitary  law  with  all  speed  and  force  and  wisdom, 
I  am  firmly  of  the  opinion  that  it  offers  but  a  partial  solu- 
tion. The  most  that  it  can  do  is  to  remove  untoward  con- 
ditions. The  essence  of  the  matter  is  personal  hygiene  and 
its  underlying  ideals.  In  this  regard  the  most  favored 
class  is  not  materially  in  advance  of  the  less  favored.  The 
essentials  of  personal  hygiene  are  few  and  simple,  but  by 
no  means  easy  of  attainment,  for  there  is  involved  that 
most  difficult  factor,  self-discipline.  It  is  absurd  to  seek 
the  possession  of  health  in  sanitary  enactments.  It  is  not 
a  matter  of  law,  but  of  character.  On  the  surface,  this  is 
not  very  obvious.  Life  is  so  automatic,  specific  resistance 
and  vigor  differ  so  widely  in  different  individuals,  and, 
especially,  cause  and  effect  are  so  far  separated  in  time,  that 
this  picture  is  of  necessity  obscure.  Nevertheless,  I  am 
convinced  that  any  individual  can  materially  enhance  his 
health,  and  increase  his  resistance  to  external  attack,  b^^ 
judicious  living.  If  that  be  true,  it  follows  that  education 
and  character  are  the  cornerstone  and  keystone  of  the 
structure. 

Assuming  this,  how  does  it  bear  markedly  on  rural  con- 
ditions? In  principle,  not  more  than  in  all  environments, 
in  practice,  in  promise,  in  possibilities,  it  is  of  immediate 
significance.  Self-respect  and  freedom  are  the  birthright 
of  the  farmer.  They  are  also  the  basis  of  character.  In 
so  far  as  they  fail  of  full  development,  a  blight  is  upon  the 
harvest. 

Is  it  a  far  cry  from  the  fundamentals  of  farm  life  and  its 
psychology  to  health  ideals?  I  hope  so.  I  have  no  faith 
in  remedies  less  searching  and  remote.     Let  me  be  not 


372  HENRY     BAIRD     FAVILL 

diverted  from  my  philosophy  by  obvious  disconnection  and 
apparent  indirection.  Do  you  recall  the  wisdom  of  the  men 
called  upon  to  administer  the  Rockefeller  fund  for  the  im- 
provement of  education  in  the  South?  Do  you  recall  that 
they  discovered  that  what  was  the  matter  was  lack  of  pro- 
ductiveness of  the  land,  hence  lack  of  money,  hence  lack  of 
independence?  Did  they  begin  by  supplying  money  for 
schools?  You  recall  that  they  began  by  educating  the 
planters  in  the  art  of  agriculture;  confident  that  schools 
would  follow  that  uplift.  So  here  the  psychology  of  rural 
life  is  what  we  need  to  study.  Upon  it  turns  the  entire 
hygienic  and  economic  future. 

Farm  life  is  not  a  bed  of  roses,  but  its  advantages  and 
compensations  are  far  from  being  appreciated  by  those 
engaged  in  it.  Drudgery  and  routine  and  monotony  are 
there,  but  not  to  compare  with  most  city  occupations. 
Mental  isolation  is  there,  an  incubus  more  than  offsetting 
the  advantage  of  physical  separation.  It  is  this  that 
breeds  conservatism,  upon  which  the  State  has  counted  for 
a  large  measure  of  its  stability;  but  it  leads,  too,  to  ultra- 
conservatism  over  which  we  stumble  in  social  advance. 
Small  margin  of  profits  is  there,  leading  in  the  best  type  to 
frugality,  and  in  the  worst  type  to  shiftlessness.  Desire 
and  prospect  of  property  are  there,  leading  to  a  jealous 
hostility  to  imposed  expense  that  may  defer  economic 
independence.  Inertia  is  the  result,  a  static  factor  to  be 
overcome  from  within,  and  but  indirectly  from  without. 

A  deeper  consciousness  in  the  farmer  of  his  relation  to 
life  is  the  desideratum.  Not  only  are  the  dignity  and  im- 
portance of  his  function,  as  the  producer  of  the  world's 
sustenance,  important  for  him  to  realize.  A  larger  lesson 
of  self-assertion  and  a  comprehensive  view  of  his  commercial 
relation  are  essential  to  his  full  sense  of  freedom.  Out  of 
this  will  grow  his  clearer  view  of  adaptation  of  means  to 
ends;  proper  utilization  of  resources;  economy  of  effort; 
and  truly  ethical  conservation.     Pursued  to  their  end,  they 


M  ]']  I)  F  ('  I  N  K      AND      [Ml  J5  L  [  C      W  K  A  f.  T  ir  37.^ 

would  cvok(!  notliin^'  hul  sclf-esteern .  Self-respect  involves 
a  deeper  note.  It  demands  civic  consciousness,  a  sense  of 
community  responsibility,  participating,  not  selfish,  life. 
That  motive  is  beneath  all  great  accomplishment.  It  is 
simple  and  vilnl. 

But,  it  may  be  commented,  the  j)hysical  and  industrial 
conditions  are  unfavorable  to  community  life.  The  farmer 
has  scant  time  for  social  intercourse.  Granted.  But  he  has 
time  to  establish  his  mental  attitude  and  determine  his  own 
standards,  and  this  is  far  and  away  the  greatest  contribu- 
tion to  the  common  weal  that  men  make.  It  is  the  very 
gist  of  the  country-life  question  and  may  as  well  be  pro- 
claimed. In  many  respects  there  is  not  as  much  com- 
munity life  in  the  country  as  there  was  years  ago.  It  is 
not  safe  to  generalize  too  broadly  on  matters  so  complex. 
Yet  I  venture  to  make  this  comment:  women  on  the  farm 
have  not  the  interest  in  the  intrinsic  features  of  the  industry 
that  is  necessary  for  their  contentment  or  their  fullest  de- 
velopment. Agriculture  has  gone  in  long  strides  in  interest 
and  effectiveness.  Men  have  kept  pace  variously.  Boys 
have  grasped  it  eagerly.  Woman's  work  on  the  farm, 
arduous  as  it  is,  is  not  as  burdensome  as  it  used  to  be. 
Has  she  lightened  her  load  by  the  stimulus  that  comes  of 
real  interest  in  and  comprehension  of  the  vocation  of  which 
she  is  an  indispensable  part?  My  observation  is  that  she 
has  not. 

The  trouble  lies  in  education.  Neither  to  boys  nor  to 
girls  is  education  offered  of  a  character  to  adjust  the  matter. 
Once  more  I  am  conscious  of  the  danger  in  ^generalizations. 
I  have,  how^ever,  but  to  point  to  the  interest  and  enthusi- 
asm created  by  signal  departures  in  agricultural  pedagogy" 
to  justify  ni}^  statement.  It  is  not  likely  that  rural  educa- 
tion is  better  or  worse  than  much  city  schooling.  The 
criticism  is  almost  universal  that  we  do  not,  in  our  educat- 
ing, fit  for  life.  Our  problem,  however,  is  the  rural  school. 
Being  less  developed  and  crystallized,  it  is  probably  easier 


374  HENRY     BAIRD     FAVILL 

of  correction.  I  have  no  idea  that  simply  adapting  the 
course  of  instruction  to  practical  agricultural  subjects  will 
solve  the  difficulty.  Important  as  it  is  —  and  I  regard  it 
as  an  indispensable  factor  in  the  process  —  it  will  at  best 
furnish  information.  The  perfection  with  which  this  is 
done  will  make  the  determining  step  more  certain  and 
valuable,  but  the  determining  step  will  none  the  less  be 
needed. 

And  what  is  this  step  in  which  I  seem  to  have  such 
confidence?  Socialization  of  the  school, — an  inadequate 
phrase,  perhaps,  but  a  text.  Cities  and  towns  have  many 
social  devices,  the  country  few.  We  are  saying  a  great  deal 
of  late  about  giving  the  young  people  in  the  country  more 
social  latitude.  They  need  it,  but  our  suggestions  easily 
become  forced  and  artificial  and  in  so  far  doomed  to  fail. 
The  school  is  a  natural  center,  organized,  financed,  and 
recognized.  It  can  be  made  the  clearing-house  for  the 
community  intelligence  —  not  for  men  or  women  or  chil- 
dren, but  for  all;  the  place  where  youthful  eagerness  can 
meet  and  interact  and  in  turn  react  upon  the  mature  powers 
of  the  neighborhood;  the  place  where  information  can  be 
transformed  and  vitalized  into  knowledge,  to  the  end  that 
impression  may  become  conviction.  Only  so  can  we  miti- 
gate the  waste  of  time  and  expense  and  life  that  is  inherent 
in  our  present  methods.  All  the  precept  in  the  world,  even 
if  followed,  is  not  effective  until  life  has  ground  it  into  our 
fiber.  Need  we  always  expend  the  most  of  life  before  we 
have  fully  incorporated  our  opinions  ?  Is  there  not  a  better 
social  organization  to  be  conceived  that  will  avoid  this 
waste?  Once  more  we  fall  back  upon  our  school  system 
to  save  the  situation.     There  is  no  other  place  to  look. 

Once  more  we  are  face  to  face  with  the  weakness  of  our 
machinery.  Is  it  sound  to  look  to  the  school,  system  for 
relief?  At  present,  no;  as  an  ultimate  achievement,  yes.  If, 
in  a  generation,  that  can  come  to  pass,  it  will  be  a  triumph. 
Administrative  function  most  readily  follows  demonstration. 


M  1<:  I)  I  (•  I  N  ]<:      AND     IMJ  p.  r.  I  f      JTICALTH  375 

The  need  of  the  couiUry  is  leaders  —  men  and  women 
with  ideals  and  imagination.  They  are  there  in  abun- 
dance, undeveloped,  unheard,  wasted.  Technical  agricul- 
ture hoped  for  its  u])h'ft  from  the  agricultural  college.  In 
a  mea.surc;  it  found  it.  But  it  has  its  limitations.  Now 
comes  into  the  field  the  expert  demonstrator  under  public 
or  corporate  auspices.  It  is  a  great  step  forward.  It  has  in 
it  the  magic  factor  of  leadership.  Why  shall  we  not  inter- 
polate between  our  present  inefficiency  and  our  ideal  edu- 
cational standard  a  period  of  .social  demonstration?  This 
is  not  a  dream.  Social  demonstrations  here  and  there, 
under  average  conditions,  are  conclusive  as  to  possibilities. 
The  factor  needed  is  conception  and  plan.  Ways  and  means 
can  be  developed.  Of  all  the  fields  before  us,  the  country 
is  most  inviting. 


376  HENRY     BAIRD     FA  V  ILL 


Delivered  as  the  Address  in  Medicine  before  the  Thirty-ninth  Annual 
Meeting  of  the  Mississippi  Valley  Medical  Association,  New  Orleans, 
La.,  OctolDer  23,  19 13. 

Printed,  Loiiisville  Monthly  Journal  of  Medicine  and  Surgery,  Novem- 
ber,  1913. 

CHILD  CULTURE  THE  FUNCTION  OF 
ORGANIZED   MEDICINE 

IN  regarding  the  field  of  human  thought  one  is  impressed 
with  the  intense  activity  of  what  may,  without  exag- 
geration, be  called  social  ferment.  In  every  direction 
which  one  may  look  there  is  evidence  of  unprecedented  stir. 
Nothing  goes  along  its  familiar  lines,  nothing  maintains  its 
accustomed  pace.  The  world  is  agitated.  This  is  not  con- 
fined to  human  action ;  it  is  fully  as  marked  in  the  realm  of 
abstract  conception;  and  through  it  all  penetrates  a  spirit 
of  intellectual  adventure,  which  beyond  doubt  is  the  influ- 
ence which  is  ultimately  to  bring  some  order  out  of  very 
obvious  chaos. 

To  this  activity  we  react  variously.  The  conservative 
is  disturbed,  perplexed,  and  often  pained  by  the  radical  and 
iconoclastic  temper  of  the  time.  The  radical  is  inspired, 
stimulated,  and  often  intoxicated  by  the  wonderful  kalei- 
doscopic readjustments  which  ensue  on  agitation  of  the 
foundations.  Between  abide  the  mass  of  people,  partly 
thinking,  partly  dreaming,  partly  stolidly  accepting  the 
dictate  of  the  day. 

Superficially,  the  outlook  offers  opportunity  for  captious 
criticism.  In  the  tearing  asunder  of  the  social  fabric,  dig- 
nity of  life,  stability  of  equilibrium,  and  quality  of  taste  seem 
to  be  disregarded.  In  the  desire  to  see  the  wheels  go  round, 
the  delicate  mechanism  is  threatened.  In  the  passion  for 
ultimate  knowledge,  the  beauty  of  the  flower  is  destroyed. 

All  of  this  reacts  on  a  conservative  temperament  as  a 
profound  and  distressing  influence.  Foreboding  precludes 
hope  and  disapproval  engulfs  discrimination.     Superficially, 


M  EDICT  NK      ANT)      J'  IJ  (U,  I  f       FII'.AJ.'III  377 

too,  the  outlook  offers  imdm;  encouragement  to  those  who 
look  for  the  regeneration  o[  soeiety.  To  them  reeognition 
means  vietory;  and  destruction  of  the  surface,  and  stirring 
of  the  depths  means  but  preparation  of  the  soil  for  a  new  and 
better  harvest.  Enthusiasm  smothers  judgment  ancl  change 
is  too  lightly  accepted  as  progress. 

Philosophy  dictates  a  tolerant  scrutiny  of  these  currents 
and  countcrcurrcnts.  It  is  fjuitc  obvious  that  there  is  a 
scientific  relationship  between  these  static  and  dynamic 
forces.  Humanity  has  never  advanced  with  even  stride, 
nor  by  purposeful  direction,  nor  by  consecutive  process. 
The  hope  of  the  philosopher  is  that  time  will  determine 
more  evenness,  better  direction,  and  more  coherent  efTort. 
Justification  of  this  hope  lies  not  in  the  broader,  deeper,  and 
sounder  conceptions  of  social  alffairs  in  the  abstract,  but  in 
the  greatly  increasing  approach  to  social  conception  as  a 
wide  dissemination. 

The  possibilities  of  human  conception  and  thought  are 
not  materially  greater  to-day  than  in  the  days  of  Caesar 
or  Cicero  or  Plato  or  Moses,  but  distribution  of  intelligence 
throughout  the  mass  of  men  capable  of  apprehending  and 
ultimately  vitalizing  such  conception  constitutes  the  basis 
of  encouragement.  The  wisest  man  of  to-day  knows  not 
essentially  more  than  the  wisest  man  of  thousands  of  years 
ago.  Legions  of  men  to-day  are  approximately  peers  of  the 
shining  intellectual  lights  of  the  ancients. 

Inevitably,  authorit}^  wanes  under  this  illumination. 
Inevitably,  diffusion  supplants  linear  projection.  In  the 
field  of  thought,  as  in  the  field  of  geography,  there  has 
been  a  frontier  and  a  pioneer.  In  the  field  of  thought,  as 
in  the  field  of  geography,  that  period  is  approaching  its 
close.  The  settler,  developer,  and  the  harvester  from  now 
on  are  to  be  reckoned  with,  and  in  that  period  the  interplay 
of  reciprocal  values,  of  rights  and  privileges  between  indi- 
viduals, and  between  individuals  and  the  mass,  must  find 
their  solution. 


378  HENRY     BAIRD     FAVILL 

At  this  moment  the  significant  note  is  freedom  of 
thought.  When  we  are  disposed  to  bemoan  the  ridiculous 
domination  of  fashion,  let  us  reflect  on  the  facility  with 
which  tradition  is  thrown  to  the  winds.  As  we  view  with 
discouragement  the  ever-recurring  domination  of  vicious- 
ness,  let  us  appreciate  the  spontaneity  with  which  people 
respond  to  an  ethical  slogan. 

Imitation  has  determined  social  custom.  Initiative  will 
loosen  its  fetters.  This  will  not  destroy  the  need  for  wisdom, 
tolerance,  and  equilibrium,  and  through  the  seething  mass 
of  human  activity  there  will  continue  to  move  an  ever- 
increasing  element  of  sane,  philosophic,  and  conservative 
progressivism. 

To  the  progress  imaginable  under  this  combined  move- 
ment of  social  stir  and  philosophic  development,  freedom  of 
thought  is  essential.  It  is  the  atmosphere  in  which  things 
can  grow,  and,  for  every  license  to  which  this  emancipation 
leads,  manifold  measure  of  liberty  will  be  poured  forth. 

Consciously  or  unconsciously  through  it  all  we  are  sound- 
ing another  note.  To  a  degree  never  before  approached, 
posterity  is  the  subject  of  solicitude. 

Labor  fights  to  the  death  for  principles  which  can  never 
materially  affect  the  present  participants.  Political  re- 
formers immerse  themselves  in  labor  and  study  whose  frui- 
tion can  be  not  less  than  a  generation  hence.  Sociologists 
grapple  problems  in  the  light  of  the  future,  and  great  ethical 
movements,  seeking  to  justify  and  readjust  human  rela- 
tions, plunge  with  intensity  into  a  struggle,  the  benefits  of 
which  can  only  accrue  to  our  children  and  children's  chil- 
dren. Conservation,  the  shibboleth  of  political  economists, 
justifies  only  in  its  relation  to  coming  centuries.  While  im- 
mediate advantage,  selfish  interest,  and  short-sighted  greed 
play  a  role  as  acute  now  as  ever  in  the  past,  it  is  being 
offset,  and  in  a  large  measure  ultimately  will  be  destroyed, 
b}''  the  overpowering  force  of  foresight. 

The  substitution  of  solicitude  for  the  race,  as  a  motive. 


M  K  D  r  f  I  N  I-:      AN!)      [Mf  H  [.  I  C      11  I.  A  I.  T  H  379 

for  desire  for  ])rescnl  .'ind  personal  advantage,  is  the  most 
important  etliieal  prodnet  of  eivilization. 

For  the  most  part  in  the  past,  soeiologic  effort  has  been 
directed  toward  rectifying  the  conditions  under  which  fu- 
ture generations  shall  be  developed.  Thought  has  been  ex- 
pended on  political  construction,  economic  facility,  social 
opportunity,  and  aesthetic  development.  Environment  has 
been  recognized  as  a  factor  of  paramount  importance  in  the 
struggle  for  existence  and  in  the  pos.sibilitics  of  symmetrical 
growth. 

Hand  in  hand,  constructive  reform  and  philanthropy 
have  attacked  world  problems,  increasing  in  their  com- 
plexity with  the  increase  of  population.  The  thought  of 
mankind  is  directed  with  such  intensity  on  these  problems 
as  to  ensure  in  the  progress  of  time  a  large  measure  of  cor- 
rection of  the  vices  which  in  the  past  have  determined  and 
perpetuated  intolerable  conditions. 

Change  in  social  understanding  and  belief  in  respect  to 
most  conditions  within  a  comparatively  few  years  has  been 
profound  and  almost  universal.  The  best  product  of  social 
thought  is  no  longer  to  be  confined  to  this  or  that  focus  of 
enlightenment.  Sporadic  and  isolated  solution  of  social 
difficulties  is  rapidly  to  be  supplanted  by  world-wide  recog- 
nition of  its  merit,  and  rapid  adoption.  In  world  affairs 
solidarity  is  already  in  sight,  and  the  best  attainable  any- 
where is  sure  to  be  prevalent  everywhere. 

As  a  natural  sequence,  the  thought  of  mankind  is  being 
directed  at  the  coordinate  term  of  the  proposition.  The 
burning  question  becomes,  how  shall  the  stock  for  which 
this  environment  is  being  created  be  improved  ?  The  prob- 
lem presents  itself  under  the  concrete  term,  Eugenics. 

As  the  significance  of  this  question  dawns  on  the  intelli- 
gence of  man,  it  assumes  stupendous  proportions.  In  the 
light  of  human  nature,  social  structure  and  spiritual  philos- 
ophy, the  problem  presents  infinite  perplexity.  Biologic  law 
is  universal.     Human  manipulation  of  that  law  inevitably 


380  HENRYBAIRDFAVILL 

perverts  the  course  of  Nature.  The  checks  and  balances 
of  animal  existence,  depending  on  natural  selection  under 
the  principles  of  the  survival  of  the  fittest,  have  been  in 
a  large  measure  nullified.  We  have  moved  much  faster 
in  the  protection  of  the  individual  than  in  the  protection  of 
the  race.  The  result  is  portrayed  to  us  in  burning  words 
and  convincing  illustration,  by  those  who  analyze  existing 
conditions.  The  relation  of  crime,  insanity,  pauperism,  de- 
generation, and  social  degradation,  to  primary  individual 
defect,  has  been  demonstrated  irrefutably.  The  cry  is  echo- 
ing through  the  wilderness,  "Reform  or  perish." 

Thus  far  all  that  has  been  accomplished  is  a  marshaling 
of  facts  which  serve  as  a  basis  for  the  contention  that  condi- 
tions preceding  birth  must  be  controlled.  As  an  individual 
exposition  the  facts  of  heredity  and  the  social  penalty  paid 
for  ignorance  of  or  indifference  to  these  facts  are  appalling. 
It  is  easy  to  prove  the  calamity  which  follows  unrestrained 
breeding  of  defectives.  Inevitably,  the  world  will  take  cog- 
nizance of  this  problem  and  in  a  measure  meet  it,  but  the 
problem  so  presented,  immediate  and  urgent  though  it  be, 
is  a  small  part  of  the  essential  matter. 

Sociologists  have  been  able  with  confidence  to  attack 
this  extreme  of  malignant  disease.  Although  thus  far  prac- 
tical methods  of  correction  have  not  been  evolved,  it  is  not 
a  remote  probability  that  tremendous  improvement  can  be 
effected  by  comparatively  simple  legislative  and  social 
effort.  It,  however,  constitutes  what  may  be  called  but 
the  negative  phase  of  the  proposition.  Our  thought  in  the 
matter  primarily  and  for  a  long  time  in  the  future  will  be 
concentrated  on  determining  what  shall  not  happen.  The 
study  of  delinquency  as  a  mass  problem  and  defectiveness 
as  an  individual  problem  will  go  hand  in  hand  toward  eradi- 
cation of  the  grosser  lesions  of  social  pathology.  Demand 
of  the  body  politic  for  relief  from  the  burden  of  social  dis- 
ease will  in  time  determine  the  prevention  of  conditions 
whose  causes  are  obvious  and  whose  correction  may  prove 


M  I-:  T)  I  c  I  N  I-:    A  N  [)    p  \J  M  [.  I  r:    [i  k  a  r.  t  ir       v'-;  f 

to  be  possible.  In  this  phase  of  the-  f)ii(;slion  there  is  great 
hope  and  probably  rapid  aceomplishment. 

In  the  positive  phase  of  eugenics,  however,  there  is  far 
less  likelihood  of  rapid  progress.  It  must  be  borne  in  mind 
that  what  we  may  be  able  to  attack  in  the  effort  to  elimi- 
nate defectiveness  is  vulncral)le  because  of  its  obviousness. 
There  are  certain  facts  sufficiently  manifest  to  constitute 
a  ground  for  systematic  effort;  the  subtler  facts  of  heredity, 
however,  are  by  no  means  thus  clearly  illuminated.  That 
we  are  able  with  reasonable  certainty  to  prescribe  certain 
combinations  because  of  their  hereditary  penalty,  does  not 
at  all  imply  that  we  are  prepared  to  prescribe  other  com- 
binations whose  result  shall  be  desirable.  We  shall  be  able 
in  many  ways  to  eliminate  the  worst;  we  shall  not  be  able 
to  determine  the  best. 

For  this  impasse  there  is  abundant  reason.  Our  knowl- 
edge does  not  cover  the  situation.  Biologic  law,  plain  as  it 
is,  in  its  simple  principles,  is,  after  all,  known  to  us  only  in 
its  outline.  Hereditary  transmission  is  a  simple  and  com- 
paratively unvariable  fact.  Hereditary  combination  pre- 
sents problems  of  infinite  complexity.  One  has  but  to 
review  the  comparatively  few  demonstrated  facts  of  here- 
dity in  the  modern  view  to  realize  the  difficulty  which  resides 
in  an  effort  to  control  progeny  in  the  absence  of  greater  and 
deeper  knowledge.  It  is  not  even  clear  that  combination 
of  defectives  where  defects  are  obvious  will  of  necessity 
produce  defectives.  How  much  more  obscure,  then,  is  the 
problem  of  producing  offspring  free  from  defect,  when  defect 
is  possibly  dependent,  not  only  on  latent  ancestral  character, 
but  on  the  activating  influence  of  unfortunate  combination. 

Little  by  little,  social  conscience  will  awaken  to  the 
responsibility  involved  in  these  propositions.  The  result 
of  this  will  be  a  large  measure  of  effort  to  avoid  palpably 
unpromising  mating,  which  will  in  turn  avoid  undesirable 
progeny.  This  \yil\  proceed  quite  independentl}'  of  legal 
restriction.     It  is  not,   how^ever,   to  be  hoped  that  great 


382  HENRY     BAIRD     FAY  ILL 

results  "will  be  achieved  in  the  improvement  of  the  race  above 
its  present  average  quality  until  the  limits  of  human  knowl- 
edge have  been  enormously  extended.  This  is  materially, 
but  not  solely,  dependent  on  determination  of  fact.  It 
\\dll  be  in  the  last  analysis  also  dependent  on  relative  values 
as  determined  by  social  concept.  Suppose  that  we  had 
to-day  to  choose  between  the  best  physique  and  the  best 
spiritual  nature.  In  the  light  of  the  world  development 
who  would  dare  to  subordinate  soul  to  body  ?  The  enthusi- 
astic answer  is,  let  us  have  both.  The  practical  answer  is, 
we  are  fortunate  if  we  have  either. 

As  the  terms  of  the  proposition  multiply,  theoretical 
variations  from  combination  reach  infinity,  and,  inasmuch 
as  we  have  not,  as  yet,  an  exact  conception  as  to  what  is  most 
desirable  even  in  physique,  how  much  longer  will  it  be  before 
we  have  a  conception  as  to  what  is  desirable  in  spiritual 
nature?  It  resolves  itself  into  this:  Constructive  effort  in 
eugenics  must  proceed  on  the  simplest  possible  lines,  follow- 
ing the  outline  of  experience  and  judgment  so  far  as  possible, 
but  for  the  time  being  utterly  repudiating  the  notion  of 
scientific  determination  of  the  subtler  qualities  of  human 
offspring. 

Much  can  be  done  by  the  application  of  common  sense 
and  reasonable  judgment  amongst  facts  which  are  coarse 
enough  to  be  seen,  but  theoretical  and  hypothetical  elabora- 
tion of  eugenic  schemes  looking  to  the  determination  of 
exceptional  results  are  doomed  to  failure,  and  for  that 
reason,  amongst  others,  pregnant  with  danger. 

The  most  that  can  be  accomplished  now  is  the  creation 
of  conscience,  reverence,  desire,  and  responsibility.  What 
the  future  will  bring  forth  in  constructive  possibility  I  have 
no  idea,  but  to  me  it  is  clear,  that  progress  can  be  only 
jeopardized   by   ill-advised   and   premature   assumption. 

For  the  time  being,  the  place  to  concentrate  effort  is  on 
the  elimination  of  the  obviously  undesirable.  Even  this  is 
not  simple.     When  as  a  concrete  decision  one  is  called  on 


M  IC  D  I  (    I  N  F.      ANT)      IM'IM.  If      71  F.  A  I,  Til  383 

clearly  to  (IcCinc  llic  dividing  line  between  the  fit  anrl  unfit, 
grave  responsibilities  are  involved  and  opportunities  for 
wide  difference  of  judgment  will  develoj). 

On  this  point  medicil  judgment  must  be  brought  to  bear. 
With  all  the  spirit  and  intelligence  of  the  social  forces 
actively  interested,  there  is  needed  in  this  judgment  a  factor 
of  discrimination  derived  from  trained  medical  thought. 

As  a  whole,  the  medical  profession  has  not  hitherto  ade- 
quately risen  to  the  situation.  Whereas  here  and  there 
conspicuous  examples  of  social  intelligence  are  operating 
amongst  the  professional  men,  definite  and  organized 
contribution  to  this  matter  is  lacking.  Not  only  is  physi- 
ologic knowledge  fundamental  to  the  determining  of  lines 
of  demarcation  which  shall  define  the  territory  in  which 
these  social  changes  must  take  place,  but  also,  in  the  far 
wider  task  of  bringing  the  public  mind  to  the  recognition  of 
the  needs  and  proprieties  of  the  matter,  are  the  conscious 
and  dehberate  efforts  of  medical  men  of  importance.  Legis- 
lation cannot  proceed  markedly  in  advance  of  public  opinion, 
and  public  opinion  will  be  shy  and  tardy  in  crystalHzing  on 
a  program  involving  to  so  large  an  extent  what  will  inevit- 
ably, though  superficially,  be  regarded  as  private  rights. 
It  is,  therefore,  beyond  question  that  biologic  principles 
must  prevail  in  the  solution  of  this  last  question,  and  hence 
that  it  devolves  on  the  rank  and  file  of  the  profession  to 
enunciate  and  expound  these  principles. 

Important  as  it  is  that  this  prominent  and  fairly  well 
recognized  problem  of  the  defective  in  societ}'  be  regarded 
by  medical  men  as  a  professional  responsibility,  there  is  stiU 
more  importance  in  the  other  field. 

The  question  of  constructive  eugenics,  vague  and  intan- 
gible though  it  be,  is  urgent  and  imminent. 

If,  as  I  believe  to  be  true,  social  conscience  is  funda- 
mental to  advance  in  improvement  of  the  race,  the  matter 
is  definitely  a  function  of  the  medical  profession.  In  the 
abstract,  all  philosophers  can  promulgate  generaHzations, 


384  HENRY     BAIRD     FA  V  ILL 

fairly  acceptable  to  ordinary  intelligence.  An  instant's 
consideration,  however,  convinces  us  that  such  propaganda 
achieve  no  considerable  results.  It  is  in  the  concrete  and 
immediate  proposition  that  results  are  to  be  determined. 
Popular  knowledge  will  never  be  sufficient  adequately  to 
anah'ze  the  elements  involved  in  a  given  class  of  com- 
binations. 

An  increasing  sense  of  social  responsibility  growing  out 
of  agitation  in  all  directions  is  certain  to  lead  people  to  take 
notice  of  the  existence  of  such  considerations.  Inevitably, 
at  the  point  of  action  they  must  consult  what  they  have  a 
right  to  regard  as  experts.  Practically  the  only  experts  in 
the  premises  are  the  physicians.  The  question  is  squarely 
before  us.  Shall  we  be,  so  far  as  knowledge  and  circum- 
stances permit,  experts? 

Clearly,  we  shall  not  be  unless  we  realize  our  obligation. 
Clearly,  we  can  be  trusted  as  such,  only  in  so  far  as  we  have 
met  that  obligation  by  equipping  ourselves  for  that  service. 
Preliminary  to  that  development  must  be  conviction  in  our- 
selves, that  it  is  specifically  our  business.  Having  that  con- 
viction, it  will  follow  that  to  a  tremendous  extent  and  in 
high  degree  we  must  be  the  leaders  of  the  people. 

There  is  no  reason,  however,  for  the  medical  profession 
to  await  the  day  when  the  improvement  of  child  conditions 
shall  be  something  more  than  a  mere  speculative  project. 
Immediately  before  us  lies  the  field  of  child  culture ;  myriads 
of  children  exist  and  hourly  are  born  whose  welfare  demands 
our  most  discriminating  thought.  On  us  should  be  properly 
placed  the  burden  of  determining  not  only  the  conditions 
under  which  children  shall  be  reared,  but  the  scientific 
classification  by  which  they  shall  be  grouped  and  adequately 
dealt  with.  To  this  end  medical  intelligence  must  be  vastly 
broadened  before  the  full  measure  of  its  usefulness  shall  be 
attained. 

Hitherto,  physiology  and  hygiene  have  been  more  or  less 
promoted  by  physicians.     They  have  been  looked  to  by 


MEDICINE      AND     IMMM.  I  C     HEALTH  385 

teachers  and  parents  Uyr  guidance  on  those  Hnes.  As  a 
broad  question  of  child  culture,  however,  it  is  a  foundation 
inadequate  and  unsubstantial.  Dccx^er  and  far  more  intri- 
cate questions  of  child  psychology  are  inseparable,  and  it 
is  with  reference  to  these  that  our  profession  needs  the 
strongest  impulse.  Nothing  can  be  more  short-sighted 
than  to  assume  that  the  ])rovision  of  appropriate  physical 
conditions  is  an  adequate  contribution  to  the  subject.  It 
would  be  possible  to  cripple  the  development  of  a  race  by  an 
exaggerated  hygienic  regime. 

The  prime  question  in  any  life  is  the  character  of  its 
growth.  This  cannot  be  determined  without  due  reference 
to  its  intrinsic  forces.  The  child  in  its  setting  in  society 
has  far  more  function  than  mere  living,  according  to  its 
physiologic  needs.  From  the  very  beginning  its  personality 
is  a  determining  factor  in  its  development.  The  widest 
establishment  of  hygienic  conditions  is  of  only  indirect  avail 
in  promoting  individual  growth. 

It  is  true  that  the  problem  of  ph3^sical  welfare,  being 
most  immediate,  is  most  practical  as  an  object  of  attack. 
It  is,  however,  of  the  utmost  importance  that  we  be  not 
blinded  by  our  hopes  and  achievements  in  this  field  to  the 
fact  that  physiology  and  h3?'giene  are  but  a  means  to  an  end. 
It  is  with  reference  to  this  broad  field  of  scientific  endeavor 
that  I  am  disposed  to  lay  the  greatest  stress  —  our  obligation 
to  become,  to  as  large  an  extent  as  possible,  experts.  It  is 
incumbent  on  the  medical  profession  definitely  to  qualify 
on  these  terms. 

The  question  may  very  pertinently  be  asked,  why  this 
field  is  not  properly  to  be  occupied  by  teachers  rather  than 
by  physicians.  That  it  is  to  be  occupied  by  teachers  pri- 
marily and  from  an  administrative  standpoint  is  beyond 
question.  The  answer  to  the  query^  is  this:  Teachers  can 
not  expect  to  solve  this  problem  without  assistance.  Assist- 
ance must  be  in  the  nature  of  cooperation;  the  medical 
contribution  will  be  that  of  information  and  advice.  Until 
14 


386  HENRY     BAIRD     FAVILL 

we  have  information  on  this  subject  we  have  none  to  offer. 
Until  we  have  judgment  matured  by  serious  investigation 
and  analysis  our  advice  is  worthless.  If  not  to  us,  to  whom 
shall  the  pedagogic  forces  turn  for  cooperation? 

At  the  moment,  the  organized  profession  is  disposed  to 
congratulate  itself  on  the  fact  that  the  teaching  organization 
has  definitely  entered  into  cooperative  effort  in  the  direction 
of  school  hygiene.  It  is  essentially  a  slow  process,  but  the 
promise  of  great  achievement  is  directly  before  us.  The 
teaching  organization  will  have  similar  reason  for  con- 
gratulation when  it  shall  have  fully  enlisted  the  medical 
profession  in  cooperative  study  of  psychology  and  pedagogy. 

There  is  a  further  reason  why  physicians  are  primarily 
related  to  this  phase  of  child  development.  Their  contact 
with  the  subject  is  earlier.  From  birth  to  the  time  when 
teachers  have  access  to  the  subject,  the  field  is  held  exclu- 
sively by  physicians  and  parents.  Inevitably,  parents  must 
receive  guidance,  if  at  all,  from  their  medical  advisers.  The 
fact  that  they  are  not  habitually  so  guided  to-day  is  not 
the  fault  of  the  parents.  It  is  due  to  the  inadequacy  of  the 
physicians.  We  have  not  made  ourselves  competent  advis- 
ers in  this  direction.  Again  the  question  arises,  why  need 
this  be  a  medical  function  ?  Why  are  not  parents  sufficient 
unto  themselves  in  this  responsibility? 

In  answer  to  this  query  and  in  elaboration  of  the  general 
statement  that  these  phases  of  development  are  interde- 
pendent, one  may  make  a  fundamental  statement :  Health 
is  a  function  of  character.  If  this  be  true,  and  the  broader 
and  deeper  the  scrutiny  the  more  incontrovertible  it  is 
shown  to  be,  it  is  beyond  question  that  growth  in  physi- 
ology and  psychology  must  be  concomitant. 

Under  civilized  conditions,  maintenance  of  health  be- 
comes a  question  of  self-restraint.  It  must  be  borne  in  mind 
that  natural  law  in  this  respect  is  in  abeyance.  Our  habits 
are  essentially  of  our  own  creation,  not  exactly  dictated  by  ne- 
cessity.    Whereas  sanitary  science  can  control  in  a  measure 


M  10 1)  I  (  I  N  I-:    AND    I'  i;  I'.  1. 1  (     II  [•:  a  i,  i  ii       3H7 

mass  conditions  and  in  a  measure  protect  an  individual 
against  the  mass  and  the  mass  against  the  individual,  never- 
theless these  activities  are  of  a  coarse  and  gencTalized  type 
and  unrelated  for  the  most  part  to  individual  life  and  habit. 

The  determining  facts  in  individual  welfare  are  related 
to  understanding  and  discipline.  Great  progress  in  physical 
welfare  of  the  race  will  not  be  made  until  the  individual 
components  of  society  are  thoroughly  imbued  with  ideals 
as  to  health  standards  and  obligations,  and  moreover  until 
they  react  keenly  to  such  ideals. 

It  follows,  therefore,  that  evolution  of  the  child  mind 
is  as  fundamental  in  its  relation  to  its  health  problems 
as  to  its  mental  or  moral  problems,  and  we  as  physicians 
are  not  justified  in  standing  aloof  from  this  child  creature 
to  say,  "Lo,  we  will  deal  with  this  child's  body;  let  some- 
body else  mold  its  soul." 

Clear  though  it  may  be  that  the  sound  body  is  funda- 
mental to  racial  advancement,  it  is  equally  incontro- 
vertible that  sound  bodies  in  general  will  not  prevail 
except  under  most   careful   mental   and   spiritual  culture. 

It  is  not  enough  that  in  our  supervision  of  child  life 
we  undertake  to  provide  physical  conditions  and  avoid 
pernicious  customs  in  early  life.  It  is  true  that  unless 
we  succeed  in  clearing  away  the  upgrowth  of  years, 
which  at  present  tends  to  hamper  and  often  destroy 
child-life,  we  shall  not  be  able  to  accomplish  anything. 
It  is  also  true  that  clearing  that  field  should  be  but 
preparatory  to  the  real  culture  to  which  the  child  is  en- 
titled. 

It  is  evident  that  the  child  should  not  be  worked  before 
the  proper  age.  It  is  just  as  true  that  he  should  be  properly 
worked  at  the  proper  age.  We  know  that  he  should  be 
protected  during  given  periods  from  knowledge  and  con- 
tact with  some  matters  and  subjects.  Do  we  realize  that 
he  should  be  deliberateh"  and  definitely  led  into  contact 
with  those  subjects  at  the  proper  time' 


388  HENRY     B  A  I  R  D     F  A  V  I  L  L 

We  should  recognize  that  there  is  a  period  in  Hfe  when 
freedom  of  thought  and  action  and  initiative  is  of  essential 
importance  to  the  budding  mind,  but  we  should  also 
recognize  that  there  comes  a  time  when  specialized  and 
strongly  disciplinary  direction  is  of  paramount  importance. 

Many  of  us  know  the  importance  to  the  very  young 
of  protective  measures  as  to  food,  clothing,  and  environ- 
ment; few  of  us  realize  the  far  greater  protective  value 
of  hardihood,  which  can  be  cultivated  by  an  intelligent 
withholding  of  such  protections. 

Where  to  draw  that  line  is  a  delicate  question,  but 
that  the  drawing  of  that  line  is  fundamental  to  physical 
stamina,  I  have  no  question.  One  can  multiply  indefinitely 
the  points  of  view  from  which  to  see  this  child  question, 
and  from  each  of  which  one  could  discern  the  importance 
of  discriminating  judgment  as  to  what  should  be  done  for 
and  with  children. 

In  summing  up,  the  conclusion  is  inevitable  that,  on 
the  whole,  the  questions  involved  are  questions  to  be 
adequately  met  by  professional  thought.  Perhaps  not 
solely  by  physicians,  but  distinctly  by  physicians  as  a 
class  in  cooperation.  Again  the  question  presents  itself, 
and  I  repeat  it  because  of  its  fundamental  importance, 
are  we  qualified  for  this  responsibility? 

As  a  partial  answer  to  that  question,  are  we  not  en- 
titled to  comment  on  and  deplore  the  fact  that  in  medical 
education  in  this  country  instruction  in  personal  hygiene 
is  almost  unknown,  and  that  instruction  in  psychology  is 
unthought  of?  In  the  light  of  the  wonderful  expanse  and 
elaboration  of  the  medical  curriculum,  there  is  but  one  ex- 
planation of  this  tremendous  defect  —  the  profession  has 
not  as  yet  assumed  responsibility  in  these  directions. 

In  casting  about  for  a  solution  of  what  seems  to  be  a 
great  weakness  in  our  medical  philosophy,  there  offers  a 
way  to  which  all  by-paths  seem  to  lead. 

I  believe  that  the  greatest  contribution  of  the  medical 


MEDICINE     AND     IMJ  H  L  I  C     HEAF.  TH         389 

profession  to  human  welfare  is  destined  to  be  in  the  further- 
ance of  child  culture.  The  magnitude  of  the  problem  Vjeforc 
civilization,  the  complexities  of  adjustments  which  are  ob- 
viously before  us,  the  inexorable  demand  of  the  economic 
struggle  on  those  who  have  matured  and  are  carrying  on 
the  affairs  of  the  world,  precludes  the  idea  of  great  reforms 
in  the  status  and  procedure  of  the  adult  race. 

What  is  to  be  accomplished  in  the  way  of  human  better- 
ment must  be  done  by  laying  broad  and  sound  foundations. 
The  lessons  of  to-day  are  learned  through  the  failures  of 
yesterday.  The  improvement  of  to-morrow  can  only  follow 
enlightenment  of  to-day. 

The  child  is  the  hope  of  the  race,  and  concentration  on 
that  hope  is  worthy  of  our  deepest  thought,  and  is  clearly 
our  noblest  purpose.  To  that  end  all  ethical  forces  in  the 
community  need  coordination,  that  there  may  be  effective 
as  well  as  harmonious  advance. 

Briefly,  I  have  stated  why  it  seems  to  me  that  the 
onus  of  this  movement  rests  on  the  medical  profession. 
Reflection  will  bring  to  any  man  trained  to  scientific  thought 
this  conviction  more  and  more  profoundly.  The  question 
then  becomes,  logically,  how  are  we  to  proceed? 

If  we  are  to  assume  our  responsibility  as  physicians 
in  this  direction,  is  it  not  primarily  incumbent  on  us  to 
formulate  and  mobilize  our  individual  conception  into  an 
organic  movement  with  a  definite  program?  Education 
and  stimulation  of  the  individual  physician  is  indispensable 
to  the  ultimate  administration  of  our  professional  duty. 
Combination  and  accord  in  the  matters  of  the  profession 
is  fundamental  to  large  and  influential  impression  of  the 
situation.  The  American  medical  profession  is  far  more 
closely  knit  into  a  coherent  and  effective  body  than  is 
usually  recognized.  Few  physicians  outside  of  the  circle 
of  administration  realize  the  extent  of  our  organization 
and  diversity  of  our  activities. 

The  most  serious  default  hitherto  has  resided  in  the 


390  HENRY     B  A  I  R  D     F  A  V  I  L  L 

fact  that  our  activities  have  been  unrelated  and  uncon- 
tinuous.  Only  recently  an  effort  has  been  made  by  the 
American  Medical  Association  to  correct  its  deficiencies. 
Three  3^ears  ago  there  was  created  by  the  National  House 
of  Delegates  a  council  designated  as  the  Council  on 
Health  and  Public  Instruction.  The  purpose  of  this  act 
was  to  combine  and  correlate  under  a  small  executive 
body,  which  for  the  purpose  of  effectiveness  was  confined 
to  five  members,  the  activities  of  the  profession  which 
relate  to  the  spread  of  intelligence  amongst  the  people 
at  large  on  all  of  the  topics  toward  which  the  medical 
profession  can  be  regarded  as  having  specific  responsibility. 

For  something  more  than  two  years  this  Council  has 
been  organized  and  in  operation.  Realizing  its  respon- 
sibility, it  has  undertaken  to  survey  the  field  of  its  pos- 
sible activities  with  care.  There  is  a  desire  and  purpose 
to  move  only  on  lines  which  can  be  regarded  as  sound, 
and  to  move  no  more  rapidly  than  is  consistent  with  stable 
construction. 

Imbued  from  the  outset  with  the  belief  that  it  is  only 
possible  to  build  effectively  and  valuably  by  building  for 
the  future,  it  early  foresaw  and  accepted  its  responsibility 
for  child  culture.  It  saw,  however,  fully  as  clearly  that 
to  attack  child  culture  as  an  isolated  proposition  was  to 
attempt  to  fly  to  the  goal  without  traversing  the  path. 
More  and  more  it  becomes  evident  that  movement  to  this 
goal  must  be  the  movement  of  a  social  army  clearly  directed 
and  thoroughly  coordinated  and  approximately  abreast  in 
the  advance  of  its  various  divisions. 

Such  an  army  is  not  made  up  of  children,  or  of 
reformers,  or  philanthropists,  or  sociologists.  It  is  made 
up  of  all  people,  and  progress  involves  the  conception  of 
a  mass  acting  intelligently  and  coherently. 

Whereas  all  great  movements  and  their  leaders  have 
seen  clearly  the  need  for  coordinated  activity,  the  practi- 
cal difficulties  in  establishing  such   correlation  are  many. 


M  I<:  I)  I  (' I  N  E      AND      I'CHLIC      HICAf.rir  .V;  i 

Lack  of  widcsprc'id  iiicuilKTsliiiJ  aiid  interest  in  any  group 
dealing  with  sociologic  matters  is  perhaps  the  most  seri- 
ous barrier  to  consistent  and  continuous  progress.  Of  all 
groups  in  the  country  at  all  related  hereto,  the  medical 
profession  is  in  the  strongest  position  with  reference  to 
its  membcrshij),  organization,  and  unity  of  thought. 

Aside  from  our  s])ccific  fitness  as  physicians  for  this 
sociologic  adventure,  our  size  and  organization  afTord 
abundant  reason  for  us  to  assume  this  leadership.  This 
Council  of  the  American  Medical  Association,  therefore, 
has  essayed  a  program  which  it  believes  is  entitled  to 
consideration. 

In  approaching  this  question  and  viewing  the  field 
at  large,  there  are  several  important  facts  that  lie  at  the 
foundation  of  its  consideration. 

Besides  great  size,  this  country  has  great  complexity  of 
organization,  and  a  question  which  involves  to  any  extent 
official  action  combined  with  popular  action  becomes  very 
involved. 

The  Council  has  undertaken,  first,  to  determine  its 
relation  to  the  national  activities  directed  toward  pro- 
tection of  public  health. 

At  the  outset  this  situation  must  be  admitted  to  be  ex- 
tremely unsatisfactory.  Although  the  Public  Health  vSer- 
vice  of  the  United  States,  so  far  as  it  goes  in  its  activity, 
is  second  to  none,  and  perhaps  better  than  any  in  the 
world,  there  are  features  involved  which  are  far  from 
ideal.  This  is  true  in  three  directions  —  with  reference  to 
its  scope,  its  autonomy,  and  its  standing  as  a  govern- 
mental function.  Related  and  distinctly  cognate  functions 
are  scattered  through  various  branches  of  administration. 
The  Health  Service,  so  designated,  is  distinctly  improperl}- 
placed  in  its  administrative  relations,  and  instead  of  being 
a  prime  function  of  the  government,  second  to  none  in 
importance,  it  has  received  scanty  recognition  as  a  public 
service. 


392  HENRY     BAIRD     FAVILL 

The  Council  feels  that  there  should  be  a  Department 
of  Public  Health  as  independent  as  any  governmental 
department,  with  its  representative  in  the  cabinet.  That 
this  must  be  the  ultimate  outcome  we  can  scarcely  doubt, 
but  the  time  seems  to  be  very  indefinite  for  its  achievement. 

It  is  a  matter  for  distinct  congratulation,  however, 
that  the  Health  Service  of  the  country  stands  in  an  atti- 
tude of  deep  sympathy  and  earnest  desire  to  cooperate 
with  all  forces,  for  the  furtherance  of  public  health,  and 
consequently  pending  the  time  of  a  proper  disposition  of 
the  matter  the  Council  is  directing  its  energies  to  establish- 
ing and  harmonizing  working  relations  with  Public  Health 
Service.  Of  still  greater  importance  in  this  country,  how- 
ever, is  the  subject  of  the  State  health  machinery. 

Whereas,  for  the  purpose  of  broad  and  coordinating 
activities,  a  national  health  service  with  power  and  stand- 
ing is  indispensable,  it  will  always  be  true  that  for  admin- 
istrative purposes  the  boards  of  health  of  the  respective 
States  are  the  points  of  deepest  significance  and  importance. 

The  survey  of  this  field  reveals  that  we  are  in  this 
respect  in  a  state  most  chaotic.  Nobody  to-day  knows 
what  the  activities  of  this  country,  measured  in  these 
units,  amount  to.  Nobody  as  yet  knows  what  should  be 
the  typical  State  board  of  health.  No  agency  at  the  mo- 
ment is  in  position  to  utilize  these  units  in  a  coordinate 
and  efficient  activity. 

The  Council  has  undertaken  a  painstaking  and  detailed 
study  of  this  question.  A  trained  sanitarian  of  the  highest 
authority  is  about  to  make  a  personal  study  of  every 
State  board  of  health,  under  the  auspices  of  the  Council. 
The  object  of  this  investigation  will  be  to  discover  existing 
facts;  to  investigate  the  work,  the  powers,  the  equipment, 
and  the  support  of  these  independent  agencies;  if  possible, 
to  determine  by  scientific  estimate  the  status  of  existing 
boards,  and  to  formulate  principles  with  reference  to  their 
organization  and  activities,  which  will  amount  to  standard- 


M  l<:  I)  I  (' I  N  10      AND      I'  IJ  I',  I,  I  (       III;  A  I.  I   II  v;3 

ization  of  vStatc  boards  (;f  health.  We  are  convinced  that 
the  work  whicli  hes  before  the  medical  profession  in  this 
enterprise  will  outweigh  by  far  all  other  [jiiblif;  health  in- 
vestigations in  importance  and  result. 

Aside  from  strictly  official  health  activities,  there  are, 
and  probal)ly  always  will  be,  in  this  country,  widespread 
activities  springing  from  jjrivato  initiative  and  supported 
by  popular  labor  and  sul'jscrijjtion.  The  importance  of 
these  achievements  cannot  be  overestimated.  The  body 
of  popular  intelligence  and  impulse  so  created,  furnishing 
background  for  administrative  effort,  is  incalculably  valu- 
able. At  the  moment,  however,  the  same  confusion  exists 
as  to  the  foundation,  purpose,  and  scope  of  these  bodies. 
There  are  more  than  seventy-five  national  ^organizations 
promoted  for  the  purpose  of  dealing  with  pubHc  health 
in  some  of  its  phases.  Early  in  its  experience  the  Council 
found  itself  dealing  with  most  of  these  in  some  way  or 
other.  It  became  manifest  that  these  bodies,  independent 
in  action  and  more  or  less  differing  in  personal  membership, 
were  working  to  a  large  extent  at  cross  purposes.  The  fact 
that  nobody  know^s  what  organizations  exist,  what  they  are 
doing,  or  what  their  foundation,  is  eloquent. 

No  matter  what  their  individual  merits,  it  needs  no 
argument  to  show  that  some  comprehensive  plan  is 
necessary  to  meet  this  situation,  and  the  Council  during 
the  last  winter  called  a  meeting  in  New  York  City,  to 
which  were  invited  the  executive  heads  of  more  than 
sixty  national  organizations.  This  meeting  was  largely 
attended,  and  resulted  in  the  formation  of  an  executive 
committee,  of  which  John  M.  Glenn,  the  Director  of  the 
Russell  Sage  Foundation,  is  chairman,  w^hich  undertakes 
to  determine  a  practical  plan  for  coordinating,  so  far  as 
may  be,  the  activities  of  volunteer  health  organizations, 
and  of  terminating,  if  possible,  the  waste  which  must  be 
involved  in  duplication  on  the  one  hand  and  neglect  of 
certain  territory  on  the  other. 


394  HENRY     BAIRD     FAVILL 

I  call  your  attention  to  the  enormous  importance  of  this 
movement.  When  ^^^ou  consider  the  great  volume  of 
personal  service  that  is  rendered  in  these  organizations, 
the  vast  sums  of  money  raised  for  their  support,  you 
will  agree  that  it  is  only  a  question  of  time  when  con- 
tributors, both  of  service  and  of  money,  are  going  to 
demand  that  somebody  shall  know  what  is  being  done, 
and  that  a  comprehensive  scheme  shall  exist  looking 
toward  effectiveness  and  the  elimination  of  waste. 

The  Council  feels  that  its  purpose  in  this  direction  is 
worth  strenuous  effort.  Although  the  foregoing  questions 
are  technically  outside  of  the  Council's  immediate  labors, 
there  is  such  relation  between  those  activities  and  its 
intrinsic  labors  as  to  make  the  establishment  of  proper 
conditions  vital.  With  reference  to  its  specific  labors  in 
the  education  of  the  public,  it  has  a  definite  view  and 
distinct  lines  of  attack. 

In  recent  years  publicity  is  recognized  not  only  as  a 
proper  but  as  an  essential  function  of  medical  progress. 
Though  the  prejudice  against  personal  exploitation  in  the 
press  has  been  modified,  only  to  an  extent  determined  by 
obvious  properties,  the  conviction  is  universal  that  the 
profession  as  a  whole  owes  it  to  the  public  to  illuminate 
the  field  of  public  health  as  broadly  and  as  intensely  as 
possible. 

The  press,  and  particularly  the  newspaper  press,  of 
the  country  furnishes  the  obvious  medium  of  communi- 
cation. The  press  is  wise  and  properly  suspicious  of 
efforts  to  exploit  personal  interest  by  means  of  specious 
appeals  to  public  interest.  It  is  not  only  not  suspicious, 
but  highly  appreciative  of  honest  contribution  to  this  end. 

For  more  than  two  years  the  Council  has  been  sending 
by  mail  every  week  to  upward  of  five  thousand  newspapers 
a  bulletin  dealing  with  current  important  public  health  sub- 
jects. These  bulletins  are  brief  and  authoritative.  It  has 
been  a  slow  matter  to  convince  the  press  of  the  inherent 


M  IC  I)  I  (    I  N  I<:      AND      IM;  l{  F.  I  (       niCAL'lll  395 

quality  .'ind  i)ur])()sc  of  llii:^  hnllctin.  flradually  the  press 
has  come  to  see  that  there  is  no  sinister  purpose,  no  private 
interest,  and  no  dan^'erous  doetrine  to  he  promulgated. 
Coineidcnt  with  that  reahzation  has  eome  enormous  inerease 
of  the  use  which  is  made  of  the  material  which  is  furnished 
in  these  bulletins,  and,  more  important,  a  far  more  satis- 
factory attitude  toward  the  profession.  There  is  reason 
to  believe  that,  as  an  educative  factor,  this  process  will 
increase  enormously  in  im])(jrtance. 

There  is,  however,  a  second  educative  effort  which  the 
Council  approves.  Human  thought  is  highly  responsive 
to  personal  leadership.  Able  and  convincing  speakers  in 
public  meetings  have  incalculable  weight  in  molding  public 
opinion.  We  have  estabHshed  a  Speaker's  Bureau  under 
the  Council,  which  is  slowly  growing  in  strength  and  facility. 

At  present  about  one  hundred  and  thirty  of  the  lead- 
ing medical  men  and  women  of  this  country  have  volun- 
teered to  deliver  from  two  to  six  lectures  during  the  season, 
at  points  remotely  located  from  their  homes,  on  public 
health  topics.  This  has  been  a  volunteer  labor.  If  the 
burden  be  not  too  great  it  is  better  by  reason  of  being 
volunteer  effort.  The  financial  burden  is  only  partially 
relieved.  The  Council  pays  the  expenses  of  the  speakers. 
The  local  body  holding  the  meeting  pays  the  expenses  of 
the  meeting,  but  cur  professional  brethren  give  by  far 
the  greater  part  —  their  time  and  effort.  Though  this 
movement  is  in  embryo,  it  is  hoped  that  it  will  grow  into 
a  massive  force. 

The  Council  is  preparing  also,  through  the  employ- 
ment of  experts,  a  series  of  pamphlets  on  public  health 
questions  largely  in  need  of  elucidation.  These  are  pre- 
pared slowly,  because  of  the  importance  of  uttering  nothing 
which  is  not  authoritative  and  satisfactorv^  in  statement, 
but  the  volume  of  definite  information  for  the  use.  not 
only  of  the  speakers,  but  of  the  public  at  large,  which  can 
be  so  disseminated  is  almost  unlimited. 


396  HENRY     BAIRD     FAVILL 

In  addition  to  the  immediate  work  of  the  Council, 
there  have  been  organized  under  this  general  supervision 
a  large  number  of  committees  dealing  with  specific  prob- 
lems. These  committees  are  made  up  of  men  who  are 
both  enthusiasts  and  experts  and  whose  activities  are 
coordinated  rather  than  directed  by  the  Council:  the 
Committee  for  the  Prevention  of  Blindness,  for  the  Pre- 
vention of  Cancer,  for  the  Study  of  Electric  Shock,  and 
so  on  through  the  list.  Through  the  Council,  these  com- 
mittees and  the  American  Medical  Association  form  a 
sympathetic  bond  of  purpose  with  non-professional  forces 
in  the  community. 

The  foregoing  sketch  of  the  plans  of  the  Council  will 
serve  to  indicate  not  only  the  comprehensiveness  of  the 
problem,  but  the  further  fact  that  popular  understand- 
ing and  education  in  this  field,  as  in  every  other,  is  funda- 
mental to  organic  law. 

Much  that  is  now  being  done  will  ultimately  be  done 
through  wise  and  simplifying  legislation.  Of  all  phases  of 
public  health  work  hitherto,  legislation  has  been  the  most 
bungling.  Well-intentioned,  ill-considered,  immature,  and 
ineffective  law  is  the  bane  of  this  situation. 

The  Council  has  established  a  Medicolegal  Bureau,  in 
charge  of  which  is  a  trained  lawyer,  the  function  of  which 
is  to  study  all  the  existing  law  in  this  country  and  others. 
Out  of  this  study  it  is  hoped  it  will  be  possible  to  draft  model 
laws  dealing  with  the  public  welfare. 

This  can  not  be  properly  done  without  medical  oversight. 
It  can  not  be  properly  done  with  medical  contribution  alone. 
In  order  to  treat  this  matter  adequately,  the  medical  point 
of  view,  the  legal  point  of  view,  and  the  sociologic  point  of 
view  must  actually  be  common.  It  is,  therefore,  hoped  that 
out  of  the  studies  which  our  bureau  is  making  may  be  devel- 
oped policies  of  action  which  the  trustworthy  forces  of  this 
country  may  definitely  promote  and  execute. 

The    House    of    Delegates    of    the    American    Medical 


M  I'M)  I  (    J  N  JO     AND     IMJ  |{  L  I  f;      II  1<:  ALT  If  397 

Association  has  clearly  enunciated  the-  principle  that  the 
medical  profession  is  inifUr  obligation  to  further  proper 
legislative  enactment.  As  clearly  it  has  declared  that  its 
function  is  educative  rather  than  ]jolitical. 

If  I  were  challenged  by  the  query,  What  has  all  this 
public  education  to  do  with  child  culture?  I  would  answer, 
Everything. 

We  cannot  mold  the  future  on  criticism.  We  cannot 
engraft  desirable  civilization  on  a  dead  trunk.  1 1  is  impossi- 
ble to  educate,  rear,  and  perfect  our  children  without  the 
intelligent  cooperation  of  the  present  generation.  The  more 
intensely  we  see  our  duty  to  posterity,  the  more  profoundly 
we  feel  the  limitations  of  contemporary  conditions. 

Never  was  there  a  time  more  ripe  for  achievement.  The 
country  is  eager  for  constructive  advance.  The  national 
administration  is  fully  sympathetic.  The  time  is  here  for 
sane,  practical  legislation. 

The  people  specifically  fitted  must  direct  this  work. 
Has  the  medical  profession,  with  its  long  history,  its  fine 
tradition,  its  unparalleled  progress,  a  higher  aspiration? 
With  its  intimate  contact,  its  insight  and  its  missionary 
character,  has  it  any  greater  opportunity? 

We  need  only  conviction  and  solidarity.  Have  we  not 
a  right  to  assume  that  the  profession  demands  of  its  organi- 
zations constructive  leadership  to  this  end? 


398  HENRY     BAIRD     FAVILL 


Delivered,  First  National  Conference  on  Race  Betterment,  Battle  Creek, 

Mich.,  January  8-12,  1914. 
Printed,  Special  Report. 

THE   NATIONAL   DEPARTMENT   OF   HEALTH 

IN  discussing  the  proposition  of  a  National  Department 
of  Health  before  this  Conference,  I  assume  that  it  is 
unnecessary  to  occupy  any  time  in  presenting  arguments 
for  the  necessity  or  importance  of  such  an  addition  to  the 
Executive  Department  of  the  Government.  It  is  equally 
unnecessary  to  present  arguments  in  justification  of  this 
movement  or  in  refutation  of  the  objections  and  criticisms 
which  have  been  advanced  by  its  opponents,  or  to  devote 
any  time  to  the  discussion  of  a  bureau  versus  a  department, 
or  to  the  exact  details  of  organization  or  of  subdivision  of 
such  a  department. 

As  the  chairman  of  the  Council  on  Health  and  Public 
Instruction  of  the  American  Medical  Association,  the  only 
justification  for  my  appearance  on  the  program  on  this  sub- 
ject is  to  present  the  attitude  of  the  organized  medical  pro- 
fession. On  this  subject  there  is  not  and  never  has  been  the 
slightest  uncertainty.  When  the  records  of  the  American 
Medical  Association  for  the  past  sixty  years  are  reviewed 
critically,  one  can  not  but  be  impressed  by  the  remarkable 
unity  of  purpose  which  has  characterized  the  profession 
through  successive  generations.  The  first  important  point, 
therefore,  to  which  I  wish  to  call  your  attention  is  that  the 
American  Medical  Association,  as  representing  the  scientific 
medical  profession  of  the  United  States,  has  throughout  its 
entire  history  stood  uncompromisingly  and  unequivocally 
for  a  National  Department  of  Health  as  a  part  of  the  execu- 
tive branch  of  government.  The  first  mention  of  such  a  plan 
appears  in  the  proceedings  of  the  American  Medical  Asso- 
ciation for  1 8  7 1 ,  shortly  after  the  organization  of  State  boards 
of  health  in  Massachusetts  and  California,  the  proposal  first 


M  !•:  [)  I  C- T  N  K      AND     PUBLIC      If  IC  A  [.  T  11         399 

taking  the;  forin  of  <'i  voluntary  council  made  u])  of  rcjjre- 
sentativcs  from  the  various  State  hoards  of  health.  In  the 
following  year,  however,  a  resolution  was  presented,  asking 
Congress  to  establish  a  National  Sanitary  Bureau.  In  1873, 
the  president  of  the  Association  stated  that  a  bill  for  this 
purpose  had  recently  been  introduced  into  Congress.  In 
1874  the  question  was  discussed  by  the  chairman  of  the 
section  on  vState  Medicine  under  the  title  "The  Waste  of 
Life,"  in  which  most  of  the  subjects  which  would  now  be  re- 
garded as  coming  under  the  conservation  of  human  vitality 
were  considered  and  the  organization  of  State  and  national 
departments  of  health  was  urged.  During  the  following 
years  discussion  of  the  questions  continued,  and  various 
bills  were  introduced  in  Congress,  culminating,  in  1879,  i^i 
the  adoption  of  a  bill  introduced  by  Mr.  McGowan,  of 
Michigan,  establishing  a  National  Board  of  Health,  one  of 
the  duties  of  which  was  to  report  to  Congress  a  plan  for  a 
National  Health  Organization.  This  board,  for  various  rea- 
sons, failed  to  take  advantage  of  its  opportunities  and,  in 
1883,  went  out  of  existence,  through  the  failure  of  Congress 
to  make  any  appropriation  for  its  maintenance.  In  1886 
a  bill  was  introduced  in  the  House  of  Representatives  by 
Hon.  Robert  T.  Davis,  of  Massachusetts,  providing  for  a 
Bureau  of  Public  Health  in  the  Department  of  the  Interior. 
In  1 89 1  a  bill  was  introduced  in  the  Lower  House  provid- 
ing a  Department  of  Public  Health  to  include  the  Marine 
Hospital  Service,  the  Bureau  of  Education,  the  Divisions 
of  Vital  Statistics,  Animal  Diseases,  and  the  Weather  Bu- 
reau. In  1892  a  bill  was  introduced  in  the  Senate  by  Hon. 
John  Sherman,  of  Ohio,  and  in  the  House  of  Representa- 
tives by  Hon.  John  A.  Col  well.  In  1897,  what  later  came  to 
be  known  as  the  Spooner  Bill,  was  introduced  in  the  Sen- 
ate by  Senator  Spooner,  of  Wisconsin,  and  in  the  House 
of  Representatives  by  Mr.  Otjen.  None  of  these  bills 
went  further  than  the  committee  stage.  At  the  1907  session 
of  the  American  Medical  Association,  the  Committee  on 


400  HENRY     BAIRD     FAVILL 

Medical  Legislation  reported  that  a  preliminary  draft  of  a  bill 
creating  a  National  Department  of  Health  had  been  drawn 
up  by  Doctor  Barshfeld,  a  member  of  the  Lower  House 
from  Pennsylvania;  that  the  American  Association  for  the 
Advancement  of  Science  had  created  a  Committee  of  One 
Hundred  on  National  Health  to  consider  methods  for  estab- 
hshing  a  National  Department  of  Health;  that  the  draft 
of  Doctor  Barshfeld's  bill  had  been  turned  over  to  Pro- 
fessor Irving  Fisher,  President  of  the  Committee  of  One 
Hundred,  in  order  that  it  might  be  redrafted  by  some  legal 
member  of  that  Committee.  The  Reference  Committee 
recommended  and  the  Association  voted  that  the  details 
of  the  plan  be  left  to  the  Committee  of  One  Hundred,  to 
which  the  Association  pledged  its  support. 

There  was  no  further  agitation  on  the  subject  until  Feb. 
lo,  1 910,  when  Robert  L.  Owen,  Senator  from  Oklahoma, 
introduced  into  the  United  States  Senate,  Senate  Bill  6049. 
This  bill,  the  original  Owen  bill,  provided  for  a  Depart- 
ment of  Public  Health,  under  the  supervision  of  a  Secretary 
of  Public  Health,  who  should  be  a  member  of  the  cabinet. 
In  this  department  should  be  assembled  all  divisions  and 
bureaus  belonging  to  any  department,  except  the  Depart- 
ment of  War  and  the  Department  of  the  Navy,  affecting  the 
medical,  surgical,  biologic,  and  sanitary  services,  including 
the  Public  Health  and  Marine  Hospital  Service,  the  Reve- 
nue Cutter  Service,  the  Medical  Staff  of  the  Pension  Office, 
Indian  Bureau,  Department  of  the  Interior,  Old  Soldiers' 
Homes,  Government  Hospitals  for  the  Insane  and  the  Freed- 
men's  Hospital,  the  Bureaus  of  Entomology,  Chemistry,  and 
Animal  Industry  of  the  Department  of  Agriculture,  the 
hospitals  of  the  Immigration  Bureau  of  the  Department  of 
Commerce  and  Labor,  the  Emergency  Service  of  the  Govern- 
ment Printing  Office,  and  all  other  agencies  in  the  United 
States  Government  for  the  protection  of  human  or  animal 
life.  This  bill  undertook  the  organization  of  a  Department 
of  Health  by  assembling  existing  parts  of  the  government' 


M  K  I)  I  C  1  N  F-:      AND     PUBLIC     H  K  A  L  T  U         40  [ 

machinery  in  a  new  department,  instead  of  creating  a  de- 
partment dc  novo.  The  Department  of  Public  Health  was 
given  jurisdiction  over  all  matters  within  the  control  of  the 
federal  government  relating  to  human  or  animal  health  and 
life.  The  establishment  of  bureaus  of  biology,  chemistry, 
veterinary  service,  and  sanitary  engineering  was  authorized. 
This  bill  was  referred  to  the  Senate  Committee  on  Public 
Health  and  National  Quarantine,  before  which  were  held 
during  the  year  following  its  introduction  a  large  number  of 
hearings.  It  was  never  reported  on,  and  died  in  committee 
with  the  expiration  of  the  Sixty-first  Congress. 

The  Second  Owen  bill  (S.  B.  i)  was  introduced  by  Senator 
Owen,  April  6,  191 1.  This  bill  provided  for  a  Department 
of  Health,  presided  over  by  a  Director  of  Health  and  an 
assistant  to  be  known  as  the  Commissioner  of  Health,  both 
to  be  appointed  by  the  President.  The  commissioner  was 
required  to  be  a  skilled  sanitarian.  The  director  was  to 
be  an  executive  officer.  The  Department  of  Health  was 
to  foster  and  promote  all  matters  pertaining  to  the  con- 
servation of  public  health,  and  to  collect  and  disseminate 
information  relating  thereto.  It  was  expressly  provided 
that  this  department  should  not  exercise  any  function  be- 
longing to  a  State  without  express  invitation  from  the 
governor  of  the  State,  or  enter  any  premises  in  any  State 
without  the  consent  of  the  owner  or  occupant  thereof. 
These  two  provisos  were  to  meet  the  objections  of  the 
advocates  of  State  Rights  and  personal  liberty.  To  this 
department  were  to  be  transferred  the  Public  Health  and 
Marine  Hospital  Service  from  the  Department  of  the 
Treasury,  from  the  Department  of  Agriculture  that  part 
of  the  Buteau  of  Chemistry  charged  with  the  administra- 
tion of  the  Food  and  Drugs  Act,  and  from  the  Department 
of  Commerce  and  Labor  the  Division  of  \^ital  Statistics  of 
the  Bureau  of  the  Census.  The  President  was  authorized 
to  transfer  at  any  time,  either  in  whole  or  in  part,  any 
bureau  or  division   of  the   government   engaged  in   work 


402  HENRY     BAIRD     FA  V  ILL 

pertaining  to  public  health,  except  the  Medical  Department 
of  the  Army  and  the  Bureau  of  Medicine  and  Surgery, of 
the  Nayy.  Provision  was  made  for  the  organization  of  the 
following  bureaus:  Sanitary  Research,  Child  Hygiene,  Vital 
Statistics  and  Publications,  Foods  and  Drugs,  Quarantine, 
Sanitar}^  Engineering,  Government  Hospitals  and  Person- 
nel and  Accounts.  An  advisory  board  of  seven  was  provided 
for,  and  provisions  were  made  for  cooperation  with  the 
health  authorities  in  the  various  States. 

This  bill  was  referred  to  the  Senate  Committee  on  Public 
Health  and  National  Quarantine,  where  it  remained  for 
almost  a  year,  at  the  end  of  which  time  it  was  reported  on 
favorably,  but  with  amendments  that  practically  amounted 
to  a  new  bill.  As  reported  out  of  the  committee,  April  13, 
191 2,  the  bill  provided  for  an  .independent  establishment 
known  as  the  United  States  Public  Health  Service,  with  a 
Director  of  Health  as  the  head.  Under  the  director  were 
to  be  three  assistants  known  as  commissioners  of  health, 
two  of  whom  were  to  be  skilled  sanitarians  and  one  a  skilled 
statistician.  The  present  heads  of  the  Public  Health  Ser- 
vice, the  Bureau  of  Chemistry,  and  the  Division  of  Vital 
Statistics  were  constituted  the  three  commissioners.  The 
duties  of  this  health  service  were  practically  the  same  as 
those  in  the  previous  bill,  with  the  proviso  that  the  health 
service  should  have  no  power  to  regulate  the  practice  of 
medicine  or  to  interfere  with  the  right  of  any  citizen  to 
employ  the  practitioner  of  his  choice,  and  that  all  appoint- 
ments should  be  made  without  discrimination  in  favor  of 
or  against  any  school  of  medicine  or  healing.  These  re- 
strictions were  inserted  in  order  to  meet  the  objections  of 
those  who  thought  that  the  liberty  of  the  individual  in  select- 
ing his  medical  attendant  would  be  interfered  with.  The 
bureaus  created  were  slightly  different  from  those  in  the 
preceding  bill,  being  bureaus  of  the  Public  Health  Service, 
Foods  and  Drugs,  Vital  Statistics,  Child  Conservation,  Sani- 
tary Engineering,  Personnel  and  Accounts,  and  Publications. 


M  TCI)  KINK      ANT)      IMMM.  If       H  i;  A  I,  T  II  403 

Followin^(  the  rcj^ort  of  Ihc  committee,  April  13,  191 2, 
the  bill  was  placed  on  the  vScnate  calendar  as  Calendar 
No.  561,  where  it  remained  until  Feljruary  3,  1913,  when  it 
was  called  up,  on  motion  of  Senator  Owen  that  the  Senate 
proceed  to  the  consideration  of  this  bill.  On  this  motion 
the  vote  was  a  tie,  33  to  t,;^.  The  bill  was,  according- 
ly, not  taken  up,  and  died  at  the  expiration  of  the  Sixty- 
second  Congress. 

April  7,  1 9 13,  in  the  opening  sessions  of  the  Sixty-third 
Congress,  Senator  Owen  introduced,  as  Senate  Bill  i ,  a  third 
bill.  This  bill  was  referred  to  the  Senate  Committee  on 
Public  Health  and  National  Quarantine. 

In  the  light  of  this  record  I  feel  justified  in  advancing 
the  following  propositions  as  generally  accepted: 

1.  The  necessity  of  some  central  federal  health  organi- 
zation is  agreed  upon  by  all  those  familiar  with  the  situation. 

2.  While  recognizing  the  paramount  importance  of 
State  activities,  owing  to  our  existing  form  of  government, 
the  importance  of  federal  activities  can  not  be  overestimated. 

3.  The  initiative  of  the  present  movement  is  largely 
due  to  the  activity  of  the  American  Association  for  the 
Advancement  of  Science  in  the  organization  of  the  Com- 
mittee of  One  Hundred,  which  movement  has  been,  from 
its  beginning,  indorsed  and  supported  by  the  American 
Medical  Association. 

4.  The  American  Medical  Association  is  and  always 
has  been  fully  committed,  by  its  repeatedly  expressed 
opinion  and  official  records,  to  the  support  of  a  National 
Department  of  Health. 

While  the  direct  results  secured  by  the  efforts  of  the 
past  forty  years  may  not  be  entirely  gratifying  to  the  friends 
of  this  movement,  the  indirect  or  reflex  efi'ect  of  the  con- 
tinued agitation  for  better  public  health  organization  has 
been  the  stimulation  of  public  health  functions,  both  of  the 
federal  government  and  of  the  various  States.  It  is  safe  to 
say  that  the  present  United  States  Public  Health  Sendee 


404  HENRY     BAIRD     FA  V  ILL 

would  never  have  reached  the  present  state  of  effectiveness 
without  the  stimulation  of  the  agitation  and  discussion  of 
this  question  which  has  been  carried  on.  Organized  in 
1789,  there  was  very  little  change  in  its  function  or  activi- 
ties for  nearly  one  hundred  years,  its  work  being  limited 
to  the  care  of  the  sailors  of  the  Merchant  Marine.  In  187 1 
Congress  placed  the  supervision  of  national  quarantine  in 
the  hands  of  the  Service.  In  1899  the  name  was  changed 
to  the  United  States  Public  Health  and  Marine  Hospital 
Service.  The  medical  service  was  reorganized,  the  hygiene 
laboratories  were  established,  and  in  191 2  the  name  was 
again  changed  to  the  United  States  Public  Health  Service, 
and  the  medical  officers  were  placed  on  the  same  basis  as 
those  of  the  Army  and  Navy  and  the  functions  of  the 
Bureau  were  considerably  widened. 

The  part  which  the  American  Medical  Association  has 
taken  in  the  campaigns  and  discussions  of  the  past  four 
years  is  too  well  known  to  require  recital. 

Following  the  advent  of  the  new  administration  and  the 
calling  of  a  special  session  of  Congress  in  April,  1913  a  con- 
ference was  held  in  Washington  on  Monday,  May  5,  at- 
tended by  the  Council  on  Health  and  Public  Instruction, 
and  the  Special  Committee  on  National  Health  Legislation 
of  the  American  Medical  Association  and  the  Executive 
Committee  of  the  Committee  of  One  Hundred  of  the  Amer- 
ican Association  for  the  Advancement  of  Science.  After 
protracted  discussion.  Professor  Fisher  formulated  a  pro- 
gram which  was  unanimously  adopted.  This  program  in- 
cluded the  following  points: 

1.  Appoint  a  committee  to  see  President  Wilson  to- 
morrow. May  6,  at  10:45,  and  communicate  to  him  the 
results  of  our  conference  and  request  him  to  decide  upon  an 
administration  policy  concerning  public  health  legislation. 

2.  Recommend  to  President  Wilson  that  he  definitely 
advocate  the  establishment  of  a  Department  of  Health. 

3 .  Recommend  that  the  President  cooperate  with  Rep- 
resentative Foster  in   attempting  to   secure  a  Committee 


M  ici)  I  c;  1  N  10     AND    im:im.  [r     III.  ai.iu        405 

on   I'ii1)lic  Ilc'iltli  in  the  House  of  Representatives  during 
llic  prcscml  .sp(!cial   session. 

4.  Recommend  that  the  President  call  a  White  House 
Conference  on  PubHc  Health  next  fall  somewhat  similar 
to  the  Governors'  Conference  on  Conservation  called  by 
President  Roosevelt.  The  object  of  this  conference  is  to 
promote  the  success  of  the  President's  policies  and  if  nec- 
essary to  aid  in  framing  these  policies. 

5.  That  at  the  next  regular  session  the  President  should 
send  a  special  message  favoring  public  health  legislation  or 
else  emphasize  it  in  his  regular  annual  message. 

6.  That  the  President  should  select  for  the  first  assistant 
Secretary  of  the  Treasury  someone  interested  in  public  health. 

7.  That  in  the  next  regular  session  we  should  support 
the  President  in  securing  such  public  health  legislation  as  he 
decides  to  recommend. 

I  call  your  attention  to  the  fact  that  the  program  adopted 
by  the  representatives  of  the  American  Medical  Association 
and  the  American  Association  for  the  Advancement  of 
Science  pledged  these  two  bodies  to  the  support  of  such  a 
program  for  public  health  legislation  as  President  Wilson 
may  see  fit  to  recommend  at  the  next  regular  session  of 
Congress,  and  that  the  record  so  far  established  by  Presi- 
dent Wilson,  in  securing  from  Congress  advanced  and  con- 
structive legislation  in  accordance  with  a  definite  policy, 
justifies  the  conviction  that  when  this  subject  is  next  taken 
up  in  Congress,  it  will  be  as  an  administration  measure,  hav- 
ing the  support  of  the  dominant  party  in  both  Houses  of 
Congress  and  the  approval  of  the  general  public.  In  the 
meantime  and  in  anticipation  of  such  a  situation,  the 
Council  of  the  American  Medical  Association  is  going 
steadily  forward  in  its  campaign  of  public  education  on 
health  topics,  recognizing  the  fact  that  an  active  and  in- 
telligent public  interest  and  support  is  of  the  first  necessity 
in  securing  the  establishment  of  this  Department  of  Health, 
for  which  the  Association  has  steadfastly  stood  during  its 
entire  existence. 


4o6  HENRY     BAIRD     FAVILL 


Delivered  before  the  Industrial  Committee,  Chicago  Association  of  Com- 
merce, AJarch  12,  1915. 

HEALTH   AND   ITS   RELATION   TO   BUSINESS 

THE  question  of  health  and  its  relation  to  business 
constantl}^  receives  more  attention  and  is  seen  to 
have  more  significance.  By  and  large,  the  variable 
quantity  in  business  efficiency  represented  by  the  actual 
and  potential  health  of  industrial  masses  is  tremendous. 

Although  the  ethical  motive  for  promoting  Public 
Health  is  not  primarily  for  the  sake  of  business,  indirect- 
ly and  essentially,  public  weal  and  business  efficiency  are 
inseparable. 

Public  Health  activities  for  the  most  part  concern 
themselves  with  mass  conditions.  The  efforts  to  establish 
and  maintain  general  conditions  which  shall  make  possi- 
ble the  maintenance  of  individual  health  are  world-wide. 
This  is  not  purely  altruistic.  It  arises  out  of  the  fact  that 
just  in  proportion  as  the  density  of  population  increases, 
the  difficulty  of  individual  self-protection  accordingly  is 
magnified.  The  State  undertakes  to  protect  those  who 
are  in  the  nature  of  the  case  unable  to  protect  them- 
selves. As  society  becomes  more  complex,  this  function 
becomes  broader.  The  future  will  see  a  degree  of  cog- 
nizance and  surveillance  over  health  matters  hitherto  un- 
approached. 

The  question  to  which  we  address  ourselves  to-day  is, 
however,  a  question  of  individual  health,  which  lies  quite 
outside  the  territory  of  State  regulation,  and  yet  of  course 
is  inevitably  modified  by  it.  In  so  far  as  individual  con- 
ceptions form  and  crystallize,  they  reflect  strongly  through 
public  sentiment  upon  the  mass  movement.  We  are  vague 
in  our  understanding  of  the  term,  health. 

Any  group  of  a  hundred  men,  moving  along  together 
in    society,    will    go    through    a    period    of   reasonable  life 


M  TC  I)  [  (■  I  N  [<:      AND      IMJP.  Lie      IIF':Ar.'[II  407 

expectancy,  .'ipparcnlly  on  (•(|ii;l1  terms.  Closer  analysis, 
however,  will  show  Ih.'it  Ix-tween  the  ages  of  20  and  30  a  cer- 
tain number  will  droj)  out  from  causes  more  or  less  related 
to  that  ])eriod  of  life;  between  30  and  40,  others  will  fall  by 
the  way;  between  40  and  50,  still  others;  and  between  50 
and  60  there  will  be  a  grand  try-out  of  the  fit  and  unfit, 
until  the  advent  of  what  may  be  called  "old  age,"  when 
only  a  remnant  will  survive  and  be  found  to  be  in  first- 
class  condition. 

The  question  will  always  arise  as  to  how  necessary 
this  diminution  in  the  ranks  may  be.  How  many  of  the 
causes  leading  to  this  situation  are  avoidable  and  correct- 
able? To  what  extent  is  this  condition  due  to  mass  con- 
ditions. To  what  extent  is  it  due  to  individual  habit? 
Even  with  regard  to  the  individual  who  has  reached 
advanced  age  in  good  condition,  is  there  any  doubt  as  to 
his  having  summed  up  a  greater  usefulness  and  happiness 
in  his  career? 

This  involves  some  discussion  of  the  nature  of  our 
physical  deteriorations.  Most  of  them  are  due,  to  a  large 
extent,  to  improper  habits  operating  through  a  long  period 
of  years.  The  difficulty  in  educating  people  to  an  ap- 
preciation of  this  fact  is,  for  the  most  part,  due  to  the 
fact  that  untoward  results  are  separated  from  their  causes 
by  a  lapse  of  time  so  great  as  to  quite  obscure  the  con- 
sciousness of  cause  and  effect.  It  is  a  fair  question,  Is  a 
man  in  perfect  physical  condition  a  more  effective  factor 
in  business  than  a  man  who  is  not  so  perfect? 

It  is  not  easy  to  generaHze  about  this,  and  yet  close 
analysis  of  the  matter,  from  the  standpoint  of  a  physician 
deaHng  with  all  conditions  and  all  ages,  leads  to  the  con- 
clusion that  the  benefits  of  wise  living  are  not  only  mani- 
fested in  a  longer  life,  but  concurrently,  in  the  happiness, 
comfort,  and  effectiveness  of  daily  life. 

Health  as  such  is  hardly  to  be  pursued  except  as  it 
is  something  which  can  be  used  and  used  freelv.     Merely 


4oS  HENRY     B  A  I  R  D     F  A  V  I  L  L 

to  be  well,  without  reference  to  what  one  does  with  his 
ability,  is  not  ver}^  interesting.  Keeping  well  through 
intelligent  and  thoughtful  habits  is  largely  a  question  of 
personal  discipline.  It  is  far  less  a  question  of  what  one 
does  than  what  one  does  not  do.  Hygienic  living  is 
largely  a  question  of  self-denial  in  various  directions. 
It  is  one  of  the  clearest  illustrations  of  the  thought, 
"Liberty    through    discipline." 

The  personal  values  inherent  in  and  resulting  from 
self-discipline  are  immeasurable.  Out  of  this  comes  not 
onh'^  reasonable  health  but  power,  which  from  a  business 
man's  standpoint  cannot  fail  to  show  in  his  vision, 
courage,  and  endurance. 


MEDICINE      AND      IMJ  IM,  I  C      II  i:  ALT  If  409 


Delivered,  'I'wenty-firsl,  Aiiniuil  Con veiii  ii.ii  of  the  National  League  of 

Nmsinjj;  Ii(lu('ati(jn,  San  Franeiseo,  June,  1915. 
rriiiicd,  American  Journal  of  Nursing,  January,  1916. 

WHAT  THE   MEDICAL  PROFESSION   CAN  CON- 
TRIBUTE  TO   NURSING   EDUCATION 

LADIES,  graduates,  undergraduates,  and  mere  men : 
It  is  a  great  pleasure  to  be  here,  and  in  any  case  I 
have  been  so  well  brought  up  in  hospitals  that  when 
a  head  nurse  tells  me  to  do  a  thing  I  do  it.  But  apart 
from  that  acquiescence,  my  acceptance  of  the  invitation 
to  speak  here  to-day  is  an  essential  gratification  to  me  in 
being  able  to  come  and  express  the  feelings  which  I  have 
long  held  upon  the  question  you  are  considering.  I  have 
had  large  experience  with  the  training  of  nurses  in  a  way, 
and  through  the  years  which  that  experience  has  covered 
I  have  been  very  conscious  that  there  was  a  distinct  lack 
in  the  contribution  made  by  the  medical  profession  to  the 
education  of  nurses.  I  realize,  as  your  President  says, 
that  if  it  had  not  been  for  the  medical  profession  the  edu- 
cation of  nurses  would  have  been  meager,  and  halting, 
and  difficult;  on  the  other  hand,  as  compared  with  the 
contribution  the  medical  profession  might  have  made, 
what  it  has  made  is  meager.  When  you  come  to  consider 
the  relationship  between  the  nursing  body  and  the  medical 
body,  you  see  at  once  that  there  is  a  relationship  of  inter- 
dependence so  close  as  to  be  practically  unique  in  human 
affairs.  Of  course  before  there  were  trained  nurses,  there 
was  a  practice  of  medicine,  such  as  it  was.  When  I  say, 
"such  as  it  was,"  I  mean  all  that  those  words  convey. 
The  practice  of  medicine,  whether  in  public  or  private,  to- 
day, is  not  what  it  was  before  the  day  of  trained  nurses. 
It  so  happens  that  there  is  an  almost  exact  coincidence 
betw^een  modern  medicine  and  trained  nurses.  The  trained 
nurses  began  in  the  late  seventies,  and  modem  medicine 


4IO  HENRY     BAIRD     FA  V  ILL 

began  then.  So  far  as  the  necessity  of  the  nurse  was 
concerned  it  was  absolutely  dependent  upon  the  new 
thought  of  medicine,  and  the  progress  of  that  new  thought 
in  medicine  was  absolutely  dependent  upon  the  evolution 
of  an  adequate  trained  nurse,  so  this  interdependence  is 
so  great  that  it  is  inconceivable  that  there  could  be  any 
lack  of  interest  in  the  medical  profession  in  the  develop- 
ment of  the  nursing  profession.  In  the  hospital  and  in 
public  I  have  often  said,  and  now  repeat,  that  a  hospital 
is  not  made  by  its  medical  staff  —  it  is  made  by  its  train- 
ing school.  In  the  long  run  it  is,  and  will  be,  exactly  in 
correspondence  with  the  quality  of  its  training  school. 

Yet  what  have  we,  as  physicians,  done  about  it?  In 
many  ways  we  have  done  a  good  deal,  but  the  fact  is  we 
have  for  the  most  part  depended  on  having  the  education 
of  the  nurses  done  for  us,  and  what  have  we  contributed? 
Criticism,  not  unfriendly  criticism,  not  captious  criticism 
necessarily,  but  it  has  been  criticism.  Nurses  have  been 
furnished  us,  have  been  utilized,  and  have  been  educated 
and  improved  undoubtedly  through  the  process  of  criti- 
cism, but  it  has  been  essentially  negative  so  far  as  we  have 
put  anything  into  it.  In  contrast  to  that,  what  could 
we  have  done'  We  might  have  furnished  a  constructive 
program,  a  constructive  contribution  of  some  kind. 

What  do  I  mean  by  that?  Of  all  the  words  used  to 
juggle  and  to  conjure  with,  the  word  "constructive"  is  per- 
haps the  easiest  and  most  effective.  What  does  anybody 
mean  by  the  word  "constructive"  with  reference  to  the 
question  of  the  education  of  nurses?  I  am  not  sure  that 
I  know,  but  I  am  going  to  try  and  analyze  it  and  see  what 
we  do,  or  might  mean.  Let  us  stop  and  consider  the 
evolution  of  the  nurse  from  the  time  she  begins  as  a  little 
girl  to  think  of  what  she  is  going  to  do,  up  to  the  time 
when  she  goes  ahead  and  does  it.  Fortunately,  most 
nurses  go  into  nursing  for  the  sake  of  a  job,  or  not  because 
they  are  called  or  have  a  mission,  simply  because  it  is  a 


M  I<:  I)  I  (    I  N  10      A  N  D      I'  (J  15  F.  I  (       11  K  A  I.  T  H  }i  i 

practical  way  of  ^cttin^  education  and  an  independent 
livin^^.  It  is  fundamentally  an  economic  proposition  with 
the  jj;rcat  m<ajority. 

Why  do  I  say,  fortunately'  Because  the  foundation 
upon  which  a  girl  could  make  that  choice  as  a  matter 
of  mission  would  be  a  foundation  so  insecure,  so  lacking 
in  knowledge  and  intelligence  about  it,  that  she  would 
be  almost  sure  to  make  a  mistake  if  she  went  in  with  the 
idea  of  being  called,  or  with  the  thought  of  sentiment. 
I  do  not  decry  that,  but  I  realize  that  in  the  nature  of 
things  a  girl  can  not  know  what  she  is  talking  about,  or 
thinking  about,  so  fortunately  girls  do  not  go  in  because 
they  are  called,  but  because  they  want  some  way  to  earn 
a  living.  On  the  other  hand,  the  question  before  us,  as 
trainers  of  nurses  (and  I  include  myself  in  this,  because 
I  am  doing  what  mite  I  can  in  training  schools)  the  ques- 
tion is,  shall  that  experience  that  this  young  girl  has  in  the 
training  school,  be  and  remain  a  simple  economic  propo- 
sition, the  simple  acquiring  of  a  job  in  a  skilled  trade,  or 
shall  it  develop  under  the  experience,  under  the  light 
which  may  be  shed  upon  it,  under  the  gradual  evolution 
of  the  great  human  aspect  of  the  situation  —  shall  it  be 
made  to  develop  into  a  mission  in  the  end?  That  is  a 
very  different  proposition.  I  do  not  care  to  see  the  nurse 
go  into  training  because  she  feels  it  is  her  mission.  I  do 
feel  that  the  only  way  she  can  go  out  and  adequate^ 
justify  the  situation  is  with  the  conviction  that  she  has 
.a  mission.  You  see  perfectly  well  what  I  mean  by  that— 
the  transfer  from  the  mere  natural  in-going  into  a  mode 
of  livelihood,  under  the  great  light  and  warmth  and  in- 
spiration of  the  situation,  should  be  a  highly  ethical  pro- 
duction, and  there  is  all  the  difference  in  the  world  between 
the  two  situations.  And  that  is  the  thing  that  we  as 
doctors  must  strive  for.  Do  we  do  it?  Are  we  successful 
in  that  effort?  In  the  verv^  nature  of  things,  no,  not  in 
general,  not  universally;  and,  in  the  very  nature  of  things, 


412  HENRY     BAIRD     FAVILL 

yes,  ver}?-  often  with  reference  to  particular  individuals. 
But  after  all,  are  we  getting  as  large  a  measure  of  that 
spiritual  quality  in  our  graduates  as  the  situation  justifies 
and  demands?  I  think  not.  I  am  not  here  to  say  why, 
exactly,  because  to  do  that  would  mean  going  too  far 
afield.  I  simply  want  to  call  attention  to  the  situation, 
but  you  see,  as  I  outlined  this  thing,  how  the  term  "con- 
structive" begins  to  find  a  scope.  There  is  plenty  that 
can  be  done  along  this  line  of  creating  an  atmosphere,  of 
creating  a  trend  of  thought,  of  creating  an  interpretation 
of  life.  There  is  obviously  a  great  deal  that  is  construc- 
tive, that  can  be  done  by  somebody,  whoever  the  right 
somebody  may  be. 

As  to  the  make-up  of  a  nurse,  what  shall  it  be?  I 
do  not  want  to  stop  to-day  to  discuss  a  lot  of  detail  about 
qualifications  or  educational  qualities,  but  I  believe  they 
should  be  good  enough  and  high  enough,  whatever  the 
level  may  be  found  to  be,  and  that  the  same  caution  should 
be  used  in  making  the  standards,  that  must  be  exercised 
in  the  medical  profession;  that  is,  that  standards  be  not 
made  too  high.  In  the  medical  profession  we  came  near 
fixing  them  too  high  and  had  to  go  back.  Do  not  do 
that!  As  a  general  rule,  a  high  school  standard  seems 
to  me  a  pretty  good  one.  I  have  seen  girls  with  not  very 
much  education,  that  I  knew  would  do  well,  and  girls  with 
very  little  education,  that  I  knew  it  would  be  a  crime  to 
hold  back.  But,  on  the  whole,  I  would  say  we  must  have 
a  preliminary  educational  qualification  of  considerable 
consequence,  and  why?  Not  because  it  represents  any 
particular  measure  of  knowledge  that  this  candidate  has, 
or  that  we  want  this  candidate  to  have,  but  because  for 
the  most  part  it  is  the  index  of  aspiration,  and  it  is  the 
aspiration,  not  the  particular  modicum  of  knowledge  that 
anybody  may  have,  that  is  valuable. 

Secondly,  although  I  realize  the  importance  for  prac- 
tical  administrative   purposes   of   preliminary   educational 


MKDTr:iNE      AND     IMJFM.IC     H  E  A  I>  T  If  413 

qualifications,  and  am  willing  tf>  a^rcc  to  whatever  standard 
the  nursing  profession  sets,  I  am  not  willing  to  make  it  a 
crucial  qualification.  It  is  a  matter  for  the  exercise  of 
the  wisest  judgment  and  common  sense.  On  the  other 
hand,  there  is  something  we  want  nurses  to  have  before 
we  get  through,  no  matter  where  they  stop,  and  that  is 
very  difficult  for  me  to  state.  We  want  nurses  to  have 
a  point  of  view,  and  orientation  if  you  like,  of  themselves, 
with  reference  to  all  the  problems  of  life.  Well,  you  say, 
everybody  ought  to  have  that.  True,  but  the  nurse  more 
than  any  other  person,  except  the  physician.  They  are 
the  two  people  who  need  a  certain  understanding,  a  social 
orientation  above  all  others,  that  will  enable  them  to 
know  what  their  own  relationship  is  to  the  great  human 
problems  of  life.  Now  there  is  where  we  fail,  and  I  do 
not  know  but  that  it  is  inevitable  that  we  fail.  I  do  not 
know  whether  we  can  ever  do  it,  but  I  know  we  want  to 
produce  in  our  graduate  nurses  a  social  consciousness  that 
will  put  them  in  the  place  where  they  belong,  with  refer- 
ence to  the  great  privileges  and  obligations  which  sur- 
round  them. 

And  how  are  we  going  to  do  it?  What  do  we  want 
of  them?  Why  do  I  put  such  emphasis  on  this  question 
of  social  orientation? 

Well,  remember,  that  there  is  a  time  in  the  affairs  of 
men,  women,  and  children  when  there  is  access  to  the 
inner  citadel  more  pronounced,  more  vulnerable,  than  at 
any  other  time,  and  that  is  during  the  prevalence  of 
trouble,  of  sorrow,  of  sickness,  of  pain,  of  death,  or  what- 
ever may  be  involved  in  all  these  things.  There  is  a 
time  when  all  humanity  has  its  guards  down,  and  that  is 
the  time  of  contact  between  the  physician  and  the  trained 
nurse  and  the  people. 

Now.  because  of  that  time,  because  of  that  contact, 
and  because  of  that  opportunity,  there  is  a  resultant  factor, 
and  that  is  obligation.     Because  we  have  that  opportunity 


414  HENRY     BAIRD     FAVILL 

it  is  absolute^  up  to  us  to  meet  it.  And  it  is  that  thing 
that  is  so  hard  to  bring  to  nurses,  and  no  harder  to  bring 
to  them  than  to  physicians,  and  it  is  that  thing  that  is 
absolutely  necessary  in  order  fully  to  round  out  this  edu- 
cational proposition.  We  have  to  teach  our  nurses  that, 
because  of  the  peculiarities  of  their  professional  relations, 
there  is  an  opportunity  and  a  function  of  leadership,  in- 
fluence, pressure,  whatever  it  may  be,  an  opportunity  to  be 
peculiarly  influential  with  people.  Nurses  do  not  begin 
to  see  that  line  of  differentiation  between  themselves  and 
ordinary  people,  but  it  is  there,  a  line  of  differentiation 
between  them  and  everybody  else,  except  the  physician, 
and  it  is  something  well  worth  while  teaching  them,  well 
worth  trying  to  make  them  realize,  that  their  very  status 
in  the  community  involves  certain  obligations  and  certain 
limitations  that  do  not  belong  to  other  people.  That  is 
what  I  mean  by  the  point  of  view  that  we  want  to  bring 
to  them. 

What  is  leadership?  They  cannot  go  out  as  young 
girls  fresh  from  the  hospital,  and  be  pronounced  leaders 
right  off.  I  am  not  stopping  to  argue  the  question  here,  of 
preparing  our  girls  for  social  work.  I  do  not  want  every 
graduate  nurse  to  be  an  expert  social  service  nurse;  we 
have  to  make  our  selection  for  that.  I  do  not  want  every 
nurse  to  know  the  technique  of  social  service;  I  would 
like  her  to  know  the  lingo,  I  would  like  her  to  know  the 
purpose  and  quality  of  the  social  service  worker,  but  I 
am  not  arguing  for  making  every  nurse  a  social  service 
worker. 

No  young  girl  goes  out  from  graduation  with  any  of 
these  qualities  strongly  developed  that  are  going  to  make 
her  a  leader,  yet  she  is  in  the  position  for  leadership,  and 
has  a  perfectly  deflnite  moral  function  looking  thereto. 

What  is  her  next  step?  To  me  this  is  the  crux  of  the 
whole  situation:  the  continuation  of  her  education,  the 
continuation  of  her  study,  of  her  effort  to  improve  herself 


M  1<:  [)  I  ('  I  N  IC      AND      IMMM,  Ff      FI  F<:  A  I,  T  H  415 

and  make  onl,  of  lici-scH  in  li'f  nlliinaU-  form  somethinj^ 
which  is  merely  indicLled  to  her  in  her  earher  course,  and 
which,  unless  developed,  leaves  her  merely  a  skilled  worker, 
and  not  a  member  of  a  profession. 

That  is  the  tiling'  in  which  we  find  the  great  failure 
in  this  whole  situation.  Nurses  do  not  go  on,  they  do  not 
study,  they  do  not  work,  they  do  not  strive  to  develop 
themselves,  and  thereby  raise  themselves  from  the  point 
of  being  merely  members  of  a  skilled  trade  to  the  stand- 
point of  a  learned  profession.  It  is  not  within  the  power 
of  anybody  to  bring  that  to  pass,  except  with  the  nurses 
themselves,  with  such  help  as  we  can  give,  ever  looking 
toward   it. 

This  brings  me  to  another  question.  Perhaps  you 
thought  I  never  was  going  to  get  to  it.  What  can  the 
medical  profession  contribute  to  this  educational  process? 

Let  me  say  to  you  earnestly,  without  complacency, 
and  with  humility,  that  the  first  thing  we  can  contribute 
to  this  situation  is  to  put  our  own  house  in  order.  There 
is  not  anyone  who  knows  that  better  than  you  do.  That 
is  the  first  step  in  the  proposition  so  far  as  strengthening, 
amalgamating,  and  adding  quality  to  the  relationship 
between  the  medical  and  nursing  professions  is  concerned. 
That  is  not  said  in  any  carping  spirit.  I  am  not  blaming 
us  any  more  than  I  am  blaming  you.  The  point  is,  we 
are  not  in  a  position  in  reference  to  these  questions,  namely, 
point  of  view,  social  consciousness,  and  continuous  develop- 
ment and  aspiration,  to  say  that  we  are  in  any  much  better 
situation  than  you.  The  first  thing  for  us  to  do  is  to  admit 
that,  and  get  to  work  to  straighten  it  out. 

I  can  not  take  time  to  discuss  the  features  of  that.  It 
simply  means  that  everything  I  have  said  with  reference 
to  the  trained  nurse  is  still  more  true  with  reference  to 
the  medical  profession.  Everything  I  have  stated  as  a 
desideratum  in  the  trained  nurse  is  still  more  so  in  the 
case  of  the  physician. 


4i6  HENRY     BAIRD     FA  V  ILL 

Now  the  question  is,  if  we  can  clear  up  our  own  ter- 
ritory, if  we  can  clean  our  own  house  and  get  things  right, 
what-  contribution  can  we  make  to  yon  ?  What  assistance 
can  we  be'  to  you  in  the  situation  ?  Of  course  that  is  rather 
a  large  question.  There  is  no  end  of  indirect  assistance 
we  can  give,  no  end  of  positive,  affirmative,  and  negative 
things  we  can  do  that  will  be  helpful.  It  would  involve 
a  discussion  of  relationship  between  the  two  professions 
to  really  deal  with  that. 

The  thing  that  I  want  to  talk  about,  just  for  a  min- 
ute in  closing,  is  this:  In  my  opinion,  it  is  the  bounden 
duty  of  the  medical  profession  in  its  best  ranks,  in  its 
strongest  pedagogic  individuals,  in  its  men  of  largest 
influence,  to  participate  actively  in  the  formal  education 
of  nurses.  That  sounds  as  though  I  were  simply  appreci- 
ating something  already  existing.  It  does  not  exist.  Who 
are  called  on  to  deliver  lectures  to  the  nurses  in  training 
schools?  The  internes,  the  fellows  just  out  of  school,  the 
smart  young  fellows  who  are  good  assistants,  clever,  able 
young  fellows,  whose  interpretation  of  the  situation  is 
worth  very  little.  I  am  not  trying  to  underestimate  my 
young  colleagues,  but  to  make  a  picture  out  of  which  I 
draw  the  conclusion,  that  it  is  the  bounden  duty  of  the 
strongest,  most  experienced,  and  most  philosophical  men 
in  the  medical  profession,  to  participate  in  the  teaching  of 
nurses  in  any  direction  in  which  their  contribution  is  more 
valuable  than  the  perfunctory  contribution  of  somebody 
else.  I  do  not  know  how  that  is  to  be  accomplished.  The 
head  men  are  busy.  They  do  not  like  to  do  it,  they  have 
not  the  time,  and  I  don't  know  but  that  it  is  a  little  infra 
dig  to  go  out  and  lecture  to  nurses  if  you  are  the  top  man 
in  the  profession.  Maybe  it  is,  I  don't  know,  but  it  has 
got  to  be  reformed  in  some  way,  because  the  things  we 
have  to  offer  as  the  result  of  years  of  experience  and  thought 
and  elimination  and  general  interpretation,  are  the  things 
that   only   the   older   and   more   experienced   practitioners 


MKDICINFi:      A  N  f)     T  C  lU,  I  f       III.ALTJI  4r7 

have,  and  these  are  the  things  that  are  necessary  to  give 
to  our  nurses;  and  if  we  can  not  get  these  things  from  such 
men,  we  can  not  get  them  at  all. 

I  am  making  my  statement  of  belief  to  you  educators 
of  nurses  that  our  greatest  contribution  comes  in  forgetting 
our  convenience  and  giving  ourselves  as  freely  as  may  be 
asked  for  the  benefit  of  this  general  need. 


15 


4i8  HENRY     B  A  I  R  D     F  A  V  I  L  L 


Deliv,ered  at  the  Public  Meeting  of  the  Medical  Society  of  the  vState  of 

Pennsylvania,  Philadelphia,  Pa.,  September  23,  1915. 
Printed,  Pennsylvania  Medical  Journal,  November,  1915. 

THE   PUBLIC  AND   THE   MEDICAL   PROFESSION, 
A   SQUARE   DEAL 

WHEN  "Ian  MacLaren"  in  his  delightful  book, 
"Beside  the  Bonnie  Brier  Bush,"  portrayed 
William  McClure,  a  country  doctor,  he  drew  a 
picture  that  deserves  to  endure  as  long  as  there  is  litera- 
ture. Therein  he  portrayed  a  situation  which  is  elemental 
in  human  relations  and  described  a  man  uncouth  of  person, 
brusque  of  manner,  and  of  uncompromising  honesty  in  his 
dealings  with  his  fellows.  Against  this  stern  picture  shows 
the  tenderness  and  sympathy  of  a  woman  and  the  courage 
of  a  Scot.  In  this  picture,  moreover,  the  relation  of  the 
doctor  to  his  patient  is  for  the  most  part  implied  and  very 
little  described.  The  story  derives  impressiveness  in  the 
portrayal  of  the  doctor  as  related  to  his  circle.  It  is  in 
the  reaction  of  his  fellows  to  his  personality  that  the  deep 
lesson  is  to  be  learned  from  this  picture.  The  character 
may  well  stand  as  the  prototype  of  a  factor  in  human 
affairs,   of  deep   significance. 

The  relation  of  the  doctor  to  the  setting  in  which  he  finds 
himself  can  be  one  of  the  greatest  or  one  of  the  meanest 
relations  occurring  in  human  affairs. 

At  its  best  it  is  inspired.  Here  is  the  friend  in  the  hour 
of  most  poignant  need ;  the  strong  arm  at  the  time  when  the 
strongest  become  weak;  the  clear  vision  in  the  pathway 
obscured  by  tears.  Is  this  story  told  with  too  much  senti- 
ment? Consider  the  thousand  eyes  that  have  dimmed  in 
its  perusal,  the  thousand  throats  that  have  choked  and  the 
voices  that  have  wavered  in  trying  to  read  it.  The  emo- 
tions which  it  awakens  and  the  response  that  it  evokes  show 
better  than  argument  that  there  are  depths  in  the  situation 


M  IC  [)  I  (    1  N  l<:      A  N  I^      I'  n  I',  I.  I  f       II  I.  A  I.  •[   II  4i(; 

and  values  in  the  relationship  that  are  not  lightly  to  he  jjut 
aside  or  scornfully  analyzed.  There  is  here  a  function, 
important  fully  to  realize  and  clin^  to.  Where  it  stands  in 
the  great  prol)lcm  of  medical  affairs  we  may  hope  to  see, 
but  whatever  our  conclusion  may  be,  we  are  justified  in 
believing  that  there  is  a  something  fundamental.  All  of 
our  conceptions  of  the  nobility  of  the  medical  profession,  as 
distinguished  from  its  characteristics  as  a  trade,  are  bound 
up  in  the  intricacies  of  this  relationship. 

In  more  recent  years  there  has  appeared  a  work  probably 
more  widely  read,  certainly  more  vigorously  discussed,  a 
play,  "The  Doctor's  Dilemma."  This  play  and  its  preface 
constitute  the  most  vicious  attack,  of  any  intelligent  char- 
acter, ever  made  upon  the  medical  profession.  First  and 
last  in  this  utterance  there  is  painted  with  ability,  and  yet 
without  fidelity,  all  the  monstrosity  which  could  be  evolved 
from  deliberate  perversion  of  medical  science  and  profes- 
sional opportunity.  It  is  distinctly  a  horrid  picture.  It  is 
drawn  with  the  license  of  a  satirist,  pungent,  exaggerated, 
and  misleading.  From  the  standpoint  of  a  satirist  this 
attack  is  probably  not  as  venomous  as  it  appears.  Doubt- 
less there  is  a  measure  of  ethical  purpose  in  the  work.  That 
it  is  utterly  unfair  as  a  statement  of  fact  is  perhaps  less 
grievous  considering  the  unfairness  of  the  author's  similar 
attacks  upon  most  social  institutions.  Possibly  the  func- 
tion of  satire  is  to  overshoot  in  order  that  the  fireworks 
may  be  more  conspicuous. 

The  reception  of  this  play  of  George  Bernard  Shaw  is 
curiousl}^  various.  Those  who  are  disposed  to  idealize  the 
medical  profession  show  a  deep  resentment.  Those  who  are 
disposed  to  anathematize  the  profession  display  a  gleeful 
acquiescence.  Those  who  are  disposed  calml}^  fairly,  and 
intelligently  to  weigh  the  matter  recognize  in  this  unpleasant 
picture  elements  of  significance,  the  exact  degree  of  untruth 
in  the  description  of  which  is  less  important  than  a  reali- 
zation that  herein  lie  matters  crucial  to  the  whole  medical 
relation. 


420  HENRY     BAIRD     FAVILL 

The  earlier  picture  to  which  I  refer  leaves  a  sense  of 
warmth,  comfort,  and  general  ennobling.  The  latter  leaves 
only  a  bad  taste.  Nevertheless,  it  is  imperative  to  review 
the  whole  matter  as  judicially  as  possible  and  to  face  the 
facts  as  clearly  defined  as  they  may  be. 

To  those  of  us  who  know  the  real  merit  of  the  medical 
profession  and  have  an  abiding  faith  in  its  function  and  its 
future,  it  is  still  a  duty  calmly  to  consider  what  the  pur- 
veyor of  half  truths,  undigested  science,  flippant  travesty, 
may  utter  that  is  worthy  of  consideration. 

It  needs  no  attack  upon  the  medical  profession  nor 
analysis  of  such  attack  to  bring  us  into  the  attitude  which 
we  should  occupy  upon  this  question.  It  is  imperative  that 
we  scrutinize  our  situation  and  determine  the  following 
things:  What  are  the  values  in  medical  science?  Whither 
is  the  trend  of  the  profession?  Wherein  are  we  open  to 
serious  criticism? 

I  need  hardly  declare  that  within  the  limits  of  this  address 
the  answers  to  these  questions  can  be  only  suggested.  To 
all  who  have  been  anxiously  reflecting  upon  the  matter  it 
is  very  clear  that  the  practice  of  medicine  is  fraught  with 
many  perils,  fully  commensurate  with  its  intrinsic  difficul- 
ties. Through  all  time  those  who  have  felt  it  incumbent 
upon  them  to  keep  alight  the  torch  of  professional  integrity 
have  realized  the  pitfalls  which  beset  the  path  of  the  medical 
practitioner. 

Some  thirty-five  years  ago  there  was  published  a  book, 
ostensibly  for  the  guidance  of  practitioners,  particularly 
the  young.  With  great  skill  there  was  set  forth  the  ways 
and  means  of  practice  and  the  ins  and  outs  of  medical  rela- 
tions. With  distinct  acumen  was  discussed  the  psychology 
of  the'sick  and  the  well,  and  the  various  devices  whereby 
physicians  could  successfully  manage  the  conduct  of  their 
professional  relations.  To  the  uninitiated  it  was  an  im- 
pressive book.  It  had  an  enormous  sale  and  was  often  en- 
thusiastically endorsed  by  medical  men.     To  my  youthful 


M  K  T)  I  C:  I  N  E      AND     P  IJ  FJ  L  I  f !     II  IC  A  [.  T  FI  i :?  i 

mind,  as  I  recall  it  at  that  time,  it  seemed  to  embody  great 
wisdom. 

I  read  this  book  aloud  to  my  preceptor,  my  father,  and 
at  the  end  he  said,  "It  is  the  most  vicious  book  ever  pre- 
sented to  the  younj^  medical  mind.  It  is  a  presentation  of 
a  systematic,  orj^anizcd  scheme  of  medical  claj^traj;  and 
tends  enormously  to  increase  the  inevitable  and  intrinsic 
pressure  there  is  upon  the  young  practitioner  to  be  dis- 
honest." At  that  point  my  eyes  were  opened,  and  from 
that  time  I  have  never  been  without  a  consciousness  that  it 
is  only  by  the  utmost  exercise  of  self-criticism  and  judgment 
that  dishonesty  in  the  practice  of  medicine  can  be  avoided. 
It  is  not  only  the  most  serious  menace  to  the  personal 
development  and  intellectual  growth  in  the  medical  man, 
but  it  is  the  insidious,  unseen,  undermining  influence  which 
perpetually  threatens  the  confidence  that  the  pubHc  has  in 
the  profession  upon  which  it  so  seriously  depends. 

The  menace  is  augmented  by  the  fact  that  so  much  of 
it  is  not  deliberate  or  intentional;  that  it  is  so  largely  a 
reaction  of  expediency  and  bewildering  perplexity;  that  it 
is  so  frequently  carried  on  under  the  guise  of  mercifulness; 
and  above  all  that  it  is  so  much  unconscious  in  consequence 
of  the  fact  that  it  springs  from  an  intellectual  dishonesty, 
or,  more  distinctly  speaking,  unclear  thinking. 

That  there  is  in  the  profession  a  considerable  volume 
of  deliberate,  self-seeking  dishonesty  is  beyond  question. 
That,  however,  is  a  minor  matter  as  compared  with  the  dis- 
honesty of  expediency  or  obtuseness.  Deliberate  crafty 
dishonesty  of  physicians  is  very  much  like  dishonesty  in 
other  walks  of  life,  to  be  dealt  with  drastically  and  without 
compromise. 

Conventional  dishonesty  of  professional  dealing,  which 
more  than  anything  else  is  consequent  upon  a  disposition 
to  follow  the  line  of  least  resistance,  is  of  far  greater  signifi- 
cance and  gravity.  This  is  the  field  in  which  the  eminently 
respectable,  highly  successful,  intensety  popular  physician 


422  HENRY     BAIRD     FAYILL 

can  find  his  fullest  scope  without  being  personally  challenged 
either  by  his  neighbor  or  by  himself.  The  results  of  his 
deviating  are  remote  and  indirect  and  largely  detached  from 
his  personal  relation.  In  the  aggregate,  however,  they  con- 
stitute the  factor  of  instability  in  the  structure  of  profes- 
sional reliability  and  value. 

By  as  much  as  the  inherent  tendency  in  medical  rela- 
tions invites,  encourages,  and  in  the  eyes  of  some  compels 
these  compromises,  by  so  much  is  the  necessity  emphasized 
for  constant  vigilance  and  careful  self -estimation. 

To  a  large  extent  this  condition  is  determined  by  the 
fact  that  the  public  seeking  the  help  of  physicians  entertains 
an  exaggerated  idea  as  to  what  physicians  can  accomplish. 
There  are  few  relations  in  life,  perhaps  none,  in  which  peo- 
ple's affairs  are  of  such  vital  importance,  with  regard  to 
which  they  have  so  little  fundamental  intelligence  or  oppor- 
tunity to  acquire  knowledge. 

It  is  characteristic  of  the  workings  of  human  minds  to 
consider  things  which  occur  in  sequence  as  being  in  a  relation 
of  cause  and  effect.  It  is  a  tremendous  evidence  of  the 
general  kindliness  of  the  public  attitude  that  its  judgments 
in  medical  matters  are  so  one-sided.  The  fact  that  a  physi- 
cian earnestly  participates  in  the  conduct  of  a  case  of  pneu- 
monia leads  the  recipients  of  his  attention  to  believe  that 
a  recovery  is  due  to  his  skill.  It  is  very  rare  that  failure  to 
recover  is  ascribed  to  his  lack  of  skill.  The  public  is  notice- 
ably biased  in  favor  of  the  physicians  who  enter  into  its 
troubles.  This  illustration  can  be  multiplied  in  a  thousand 
directions.  The  result  is  not  only  that  people  expect  of 
physicians  determining  influence  in  matters  over  which 
they  have  no  influence,  but  that  they  attribute  to  medical 
skill  myriads  of  fortunate  events  which  have  been  practi- 
cally uninfluenced  either  by  skill  or  lack  of  skill. 

Out  of  this  attitude  of  mind  on  the  part  of  the  public, 
grows  a  tendency  in  the  physician  to  pose  as  influential  in 
the   matter,    very  difficult  to  resist.     When  one  stops  to 


M  I'",  I)  I  (•  I  N  IC      AND      IM:  i',  I,  F  r      If  K  A  I,  T  II  423 

consider  how  this  mutual  estimation  may  be  elaborated, 
continued,  and  mani])ulated,  it  is  evident  that  the  inherent 
obstacles  to  establishing  clearer  re]ationshif)S  are  very  great. 
If  to  this  be  added  on  the  part  of  the  physician  an  intellectual 
defect,  perhaps  harshly  called  intellectual  dishonesty,  which 
leads  him  to  partici])atc  in  the  flattering  judgment  as  to  his 
own  skill  or  importance  in  the  situation,  the  matter  is  vast- 
ly exaggerated.  Beyond  a  doubt  this  confusion  is  a  factor, 
in  medical  affairs,  of  tremendous  weight. 

The  profession,  by  and  large,  is  not  thinking  clearly  as 
to  its  powers  and  limitations.  It  is  participating  in  this 
misjudgment  as  to  what  it  can  do,  and  the  result  is  in  many 
directions  that  it  is  muddling  along,  failing  clearly  to  dis- 
criminate as  to  the  values  inherent  in  its  most  earnest 
endeavor.  Over  and  around  it  all  lies  the  cloud  of  profes- 
sional secrecy.  In  the  nature  of  things  the  matters  in  ques- 
tion are  tenaciously  and  sometimes  sacredly  private.  The 
authoritative  position  of  the  man  who  gives  advice,  the 
extreme  incapacity  of  the  recipient  of  the  advice  to  weigh 
it  and  judge  it,  the  utter  lack  of  expert  discussion  or  of  vary- 
ing comment,  tending  to  create  the  condition  of  the  star 
chamber,  tremendously  add  upon  the  one  hand  to  obscu- 
rity, and  on  the  other  to  undiscriminating  opinion. 

The  question  naturally  arises  as  to  why  this  misconcep- 
tion has  so  long  continued,  and  how  it  is  that,  in  spite  of  a 
considerable  recognition  of  the  facts,  the  relationship  is 
maintained  and  the  inevitable  consequences  ensue  without 
material  interruption.  It  would  be  an  intricate  analysis 
that  could  disentangle  the  conditions,  far  too  elaborate  for 
this  occasion.  In  passing,  however,  it  is  worth  while  to 
comment  upon  the  extremely  varied  character  of  matters 
that  enter  into  the  practice  of  medicine  as  it  has  developed. 
In  the  first  place,  are  the  matters  of  essential  gravity,  as 
acute  diseases,  more  or  less  dangerous  in  character,  actually 
matters  of  life  and  death?  These  constitute,  of  course,  a 
small  minority  of  the  experiences  of  a  physician,  and  yet 


424  HENRY     B  A  I  R  D     F  A  V  I  L  L 

they  are  the  point  about  which  rahy  the  deep  intensities 
of  the  physician-patient  relationship. 

Here  people's  interests  are  most  vital,  anxieties  most 
disturbing  and  dependence  most  pronounced.  It  is  at  this 
point  that  the  physician  establishes  his  indispensability,  and 
it  is  with  regard  to  service  in  these  agonizing  conditions  that 
Watson's  picture  of  "A  Doctor  of  the  Old  School"  is  so  effec- 
tively drawn.  It  is  but  natural  that  under  those  circum- 
stances people  with  everything  at  stake  and  utterly  helpless 
should  turn  with  unlimited  confidence  to  apparent  sources 
of  strength  that  are  available. 

It  is  here  that  the  physician  becomes  most  definitely 
the  friend,  and  out  of  the  glow  of  the  situation  comes  a 
deep  attachment  made  up  of  confidence,  gratitude,  and 
relief.  It  is  but  natural  that  an  intellectual  criticism  of 
all  factors  in  the  case  should  be,  in  general,  lacking.  The 
situation  is  deeply  human  and  far  removed  from  the  ground 
of  scientific  analysis.  By  the  same  token,  the  opportunity 
for  service  offered  to  the  physician  is  of  the  greatest.  It  is 
in  this  territory  that  the  rank  and  file  of  the  profession 
shines,  not  as  to  professional  achievement,  but  as  to  per- 
sonal devotion  and  honest  effort. 

Inevitably,  however,  out  of  these  very  crises  of  life  grow 
much  of  the  misconception  which  we  are  herein  discussing. 
The  physician  alone  in  this  combination  is  able  to  judge 
how  crucial  his  services  may  have  been.  Probably  he  less 
than  any  is  able  to  judge  how  comforting  his  presence  may 
have  been.  In  spite  of  himself,  in  the  end  and  in  general, 
he  will  be  credited  with  a  larger  function  of  specific  achieve- 
ment than  he  is  entitled  to.  The  simple  question  is,  will  he 
play  upon  that  situation  and  capitalize  those  possibilities, 
or  will  he  honestly  and  fairly  place  and  maintain  himself, 
as  far  as  he  is  able,  in  his  true  relationship? 

It  is  perfectly  obvious  that  he  may  have  been  utterly 
devoted  on  the  one  hand  and  not  clearly  discriminating  on 
the  other.     From  time  immemorial  physicians  have  thought 


MIODTCINK      AN!)       I'  Ij  IU.fr      1 1  I.  A  I.  I'  1 1         425 

that  way;  ])copk'  have  llioii^'lit.  tli.'it  way.  Only  just  now 
have  scientific  corrections  to  such  thought  f;penefl  up  the 
truth.  Can  we  exi)ect  logical  and  ethical  readjustments 
in  a  twinkling?  This,  however,  I  conceive  to  be  the  start- 
ing point  of  professional  relationships,  which  go  on  and  on, 
more  or  less  intensifying  a  misconception  which  has  arisen. 
A  physician's  experiences  enlarge  into  a  multitude  of  ques- 
tions which  have  no  such  immediate  serious  import.  He 
is  consulted  upon  thousands  of  matters  which  he  does  not 
materially  influence  or  which  would  not  have  been  seriously 
compromised  without  his  influence. 

It  is  in  this  territory  that  great  opportunity  occurs  for 
discriminating  conduct.  Assuming  on  his  part  a  thorough 
intelligence  as  to  the  matter  before  him,  the  question  is, 
will  he  hew  to  the  line?  Will  he  set  before  his  patient  the 
facts  as  he  sees  them?  Will  he  dismiss  without  prescrip- 
tion a  patient  who  is  better  without  prescription?  Will 
he  minimize  to  the  proper  point  the  insignificant  ailment? 
Will  he  tell  to  the  unwilling  listener,  an  unpleasant  truth? 
Will  he  in  the  various  doubts  and  uncertainties  of  the  epi- 
sode, always  regard  the  interest  of  his  patient  as  entitled 
to  the  benefit  of  the  doubt?  Will  he  avoid  the  temptation 
to  get  rid  of  a  troublesome  and  not  very  important  matter 
by  some  form  of  hocus-pocus?  All  these  and  more  are 
daily  issues  confronting  a  physician. 

There  is  no  question  that  the  best  of  physicians  punc- 
tilliously  regard  all  of  these  things.  There  is  no  question 
that  the  worst  of  physicians  will  violate  all  of  them.  But  in 
between  is  the  enormous  mass  of  practitioners,  neither  the 
worst  nor  the  best,  who  will  need  to  discriminate  according 
to  their  mental  and  moral  endowments.  It  is  utterly  unfair 
to  demand  that  all  physicians  shall  be  of  such  superior 
quality  of  mind  and  conscience  as  adequately  to  meet  a 
situation  in  which  all  of  the  adjustments  of  a  social  con- 
fusion shall  be  met  by  them.  It  is  utterly  unintelHgent 
to   attribute    abuses,    which  may  have  grown  up  in  this 


426  HENRY     BAIRD     FAVILL 

field,  to  deliberate  or  even  conscious  action  on  their  part. 

The  matter  is  clearly  a  question  of  psychology  in  which 
lack  of  intelligence  and  information  on  the  part  of  the  non- 
medical public  is  by  far  the  most  important  factor.  It  is 
no  extenuation  of  compromise  in  these  matters  to  say  and 
to  believe  that  people  prefer  to  be  fooled.  In  the  first 
place,  that  is  not  true.  In  the  second  place,  where  it  ap- 
pears to  be  true  it  is  because  the  process  of  being  fooled 
carries  with  it  satisfaction,  which  the  physician  should  learn 
to  anticipate,  and  neutralize  by  deeper  and  more  vital  con- 
tribution. 

My  function  as  a  physician  is  not  discharged  when  I  say 
to  a  solicitous  client,  "There  is  nothing  the  matter  with 
you,"  unless  that  opinion  is  fully  accepted.  And  if  my 
patient  continues  to  believe  there  is  something  the  matter 
with  him,  there  is  something  the  matter  with  him,  and  my 
function  has  not  been  fulfilled  until  I  have  made  him  see, 
as  I  see,  that  he  is  not  in  jeopardy. 

Herein  is  the  great  failure  of  the  clear  seeing,  outspoken 
physician  who  does  not  juggle  the  facts.  Too  often  he  is 
not  willing  or  perhaps  able  to  impress  upon  his  patient  to 
the  point  of  practical  conviction,  the  truth  to  himself  so 
clear.  He  has  relieved  his  conscience,  perhaps,  by  an  entire- 
ly upright  expression.  He  has  not  rendered  his  full  profes- 
sional service  until  he  has  made  it  effective.  It  is  quite 
clear,  therefore,  that  physicians  should  assume  and  mani- 
pulate the  various  methods  open  to  them  for  coping  with 
all  the  difficulties  herein  implied.  The  solution  of  the  mat- 
ter lies  in  a  two-fold  progress. 

What  is  needed  to  correct  this  maladjustment  of  medical 
service  to  popular  need  is  better  education.  The  public 
must  be  brought  to  see  that  ordinary  ailments  of  life  are  not 
necessarily  evidences  of  disease  but  are  logical  consequences, 
for  the  most  part,  of  perverted  habits  of  life.  To  any  ex- 
tent that  the  person  not  especially  trained  in  physiology 
and  hygiene  can  be  taught  sound  habits,  the  public  can  be 


MICDICINIC      AND      PCI',  I,  If      FI  l",  A  F, 'f   Ff  427 

brought  in  many  ways  and  hy  an  elaboration  of  methods 
now  started  in  so  many  directions,  to  learn  the  conduct  of 
life. 

In  order  fully  to  realize  the  possibilities  in  this  direction, 
it  is  necessary  to  inculcate  a  sound  primary  conception  of 
health.  In  the  past,  people  in  general  have  been,  toward 
health,  in  an  attitude  that  is  distinctly  negative.  The 
motive  actuating  people,  where  they  are  conscious  of  any 
motive  at  all,  has  been  a  desire  to  avoid  illness.  The  trend 
of  humanity  has  been  altogether  toward  remedies  for  mal- 
condition.  It  is  unusual  that  people  consider  the  matter  at 
all  until  attention  is  directed  to  it  by  some  form  of  discom- 
fort. It  has  been  assumed  that  health  is  automatic  and 
that  no  attention  need  be  paid  to  it  until  some  deviation 
occurs.  This  is  fundamentally  erroneous.  The  more  soci- 
ety advances  in  what  is  called  civilization  and  what  is  really 
complexity  of  relationships,  the  less  the  checks  and  balances 
of  physical  well-being  operate  automatically.  The  conse- 
quences of  complex  life,  more  dense  aggregation,  more  in- 
tricate interrelationships,  are  for  the  most  part  not  imme- 
diate, but  remote.  It  is  not  easy  to  trace  to  fundamental 
cause  many  of  the  effects  which  present  themselves  as  phy- 
sical perversions. 

The  future  demands  that  people  direct  their  attention 
toward  causes,  and  bring  to  bear  upon  themselves,  with 
reference  to  causes,  principles  of  conduct.  This  implies 
that  desire  to  avoid  sickness  be  translated  into  a  deter- 
mination to  be  in  the. highest  degree  \vell,  which  involves 
a  scrutiny  of  the  foundations  of  health  and  adoption  of 
methods  of  life  in  keeping  with  their  preservation. 

This  constitutes  in  contradistinction  to  what  I  have 
called  a  negative  conception,  an  ideal  of  health  w^hich  is 
distinctly  affirmative.  It  is  to  this  end  that  intelhgent 
effort  of  people  must  be  directed  and  along  this  path  that 
they  may  hope  to  be  guided  by  medical  thought.  Great 
as  the  need  is  in  the  public  in  general  for  such  recast  of 


428  HENRY     B  A  I  R  D     F  A  V  I  L  L 

mind  and  purpose,  the  need  is  greater  in  the  medical  pro- 
fession. 

The  most  serious  indictment  of  medical  practice  to-day 
is  that  it  is  superficial.  Unless  guidance  of  the  public  in 
this  direction  is  to  be  left  to  sociologists,  and  amongst  these, 
to  enthusiasts,  faddists,  and  blundering  well-meaners,  the 
medical  profession  must  be  not  only  better  educated  but 
differently  educated.  Not  only  is  the  profession  not  well 
trained  in  sanitary  science,  but  it  is  still  less  well  trained 
in  the  philosophy  and  principles  of  hygiene.  It  is  unthink- 
able that  a  profession  which  has  not  devoted  itself  ear- 
nestly to  a  subject  so  intricate  and  widely  ramified  can 
have  much  value  in  leading  the  populace  upon  a  safe  road. 
It  is  inevitable  that  a  profession  so  educated  shall  deal 
with  effects  rather  than  with  causes  and  shall  fail  to  discern 
and,  whether  disposed  to  shirk  or  not,  shall  be  incompetent 
to  point  out  the  logical  sequences  which  must  be  clearly 
comprehended  in  order  to  render  service  of  any  signal 
value. 

From  this  point  of  view  there  are  no  trifling  ailments  in 
medical  experience;  there  are  no  "unimportant"  matters. 
That  which  makes  the  mass  of  physicians'  problems  insig- 
nificant, is  that  they  are  dealt  with  insignificantly.  There 
is  no  so-called  minor  ailment  which  has  not  a  major  reason- 
ing within  it,  and  the  test  of  a  physician's  ability  will  be 
his  capacity  to  discern  ultimate  facts  and,  so  far  as  may 
be,  readjust  conditions. 

There  is  probably  no  part  of  this  field  demanding  such 
acumen,  patience,  and  breadth  of  view  as  mental  hygiene. 
Not  only  are  foundations  to  be  laid  better  than  now,  but  a 
larger  comprehension  of  the  relation  of  mental  to  physical 
and  social  life  must  be  acquired.  Failure  to  reahze  this  and 
to  incorporate,  with  the  materials  of  physiological  reform, 
the  patient's  mental  contribution,  is  largely  responsible  for 
superficiality  in  our  present  method.  Not  only  must  we 
see,  but  our  patient  must  see  to  the  end  before  we  have 


MiCIMCINK     A  N  IJ     IMJ  H  L  I  C     HEAf.TII  429 

accomplished  imuli.  In  this  ideal  lies  the  hope  of  the  pro- 
fession. 

As  our  confidence  in  medicinal  theraj^eutics  wanes,  as 
our  dissatisfaction  with  the  detail  of  conventional  practice 
grows,  and  as  the  trivialities  of  practice  become  more  irk- 
some, there  opens  before  us  a  field  unlimited  in  scope  and 
attractiveness,  the  philosophy  of  health  and  its  reflection  in 
the  physical,  moral,  and  social  life  of  the  community.  We 
are  the  proper  guides  to  the  public  in  this  philosophy,  but 
only  can  we  be  such  by  becoming  competent.  The  one 
reliable  counteragent  to  the  disingenuousness  and  dis- 
honesty of  medical  practice  is  better  education  of  physi- 
cians. 

What  is  the  trend  of  the  profession  and  of  the  public!' 
Beyond  a  doubt  there  is  a  strong  current  running  through  the 
medical  profession  tending  toward  a  solution  of  these  diffi- 
culties. Cooperation  between  medical  forces  and  the  lay 
public  is  becoming  marked.  A  reciprocal  function  in  the 
progress  of  matters  of  public  health  is  clearly  recognized. 
To  a  very  large  extent  this  is  due  to  the  vision  and  devotion 
of  sociologists.  To  a  very  large  extent  it  is  met  and  made 
effective  by  the  organized  policy  of  the  medical  profession. 
Those  w^ho  are  thoroughly  familiar  with  the  situation  rec- 
ognize a  common  ground  upon  which  ph3^sicians  and  laymen 
meet  with  thorough  recognition  of  their  mutual  dependence. 

As  this  movement  becomes  more  general,  and  dealing 
with  health  affairs,  in  the  abstract  and  aggregate,  progresses, 
the  educational  factor  for  the  public  and  for  the  profession 
must  be  regarded  as  of  the  utmost  importance. 

The  public  is  gradually  learning  facts,  the  profession  is 
gradually  learning  its  function,  and  side  by  side  they  are 
moving  and  destined  to  move  toward  enormous  results.  As 
barriers  disappear  between  medical  and  non-medical  activ- 
ities, community  of  thought  and  interest  becomes  obvious. 
It  is  inevitable  that  the  artificiality  and  superficiality  of 
relations  shall  disappear  in  consequence,  and  there  is  reason 


430  HENRY     BAIRD     FA  V  ILL 

to  hope  that  in  the  years  to  come  the  medical  profession 
will  assume  an  importance  and  render  a  service  such  as  has 
never  before  been  approached. 

If  I  had  time  and  this  were  the  occasion  to  pay  a  tribute 
to  sociologists  in  their  efforts  to  advance  the  physical  wel- 
fare of  the  community  and  race,  it  would  be  very  grateful 
to  me  so  to  do.  The  vision  and  purpose  shown  by  leaders 
in  that  group  command  admiration  and  compel  support. 
In  many  directions  initiative  in  social  movements  properly 
is  theirs.  As  they  have  gone  on  outlining  this  territory  they 
have  markedly  educated  the  medical  profession.  As  they 
progress,  however,  they  find  themselves  at  every  turn  con- 
fronted by  necessity  for  expert,  scientific  advice.  That 
their  need  in  this  direction  shall  be  met  by  free,  full,  and 
cordial  contribution  from  the  profession  is  earnestly  to  be 
hoped.  It  appears  in  the  present  trend  of  events  that  there 
can  be  no  question  about  such  deep  and  earnest  cooperation. 

The  American  Medical  Association  has  definitely  set 
its  face  in  this  direction  and  established  a  policy  through  its 
various  councils  with  this  distinct  purpose.  The  Council 
on  Health  and  Public  Instruction,  of  which  I  am  a  mem- 
ber, and  which  I  here  officially  represent,  has  for  its  definite 
purpose  the  promotion  and  elucidation  of  relationships 
between  the  public  and  the  profession. 

Corresponding  to  this  official  attitude  of  the  organization 
is  a  clearly  defined  recognition,  amongst  physicians  indi- 
vidually, of  the  paramount  importance  of  such  development. 
It  scarcely  needs  argument  to  show  that  the  essence  of  this 
evolution  is  fitness  on  the  part  of  the  profession  to  play  its 
part.  Medical  education  must  be  not  only  the  best  it  can 
be  in  point  of  scientific  equipment,  but  it  must  be  broad- 
ened in  its  social  aspect  to  the  point  of  maximum  value. 

Are  we  educating  our  young  men  and  women  as  broadly 
as  we  ought?  To  say  that  we  are  not  perfecting  them  at 
the  point  of  graduation  for  valuable  service  in  this  direction, 
though  obviously  true,  does  not  meet  the  point.     The  matter 


MICDICINK     AND      I'  IJ  I'.  L  I  (       lll-:AL'lil  431 

is  essentially  very  (liCficnlL.  Mcdicril  (ifhic'ition  has  become 
to  the  student  hnnlensome.  The  medieal  student  of  to- 
day is  confronted  with  a  mass  of  scientific  material  that  is 
appalling,  which  it  is  incumbent  u])on  him  reasonably  to 
master.  So  great  is  this  material  that  it  is  out  of  the  ques- 
tion for  it  to  be  incorporated  with  exactness,  and  as  infrjr- 
mation,  by  anybody  in  the  space  of  four  years. 

There  is  need  for  the  wisest  pedagogic  method  in  our 
medical  schools  in  order  thoroughly  to  accomplish  effective 
education  of  our  students.  Drilling  into  them  endless  facts, 
valuable  as  they  may  be,  will  not  accomplish  this.  Clear 
presentation  of  principles,  thorough  training  in  technique, 
and  abundant  opportunity  for  application  of  their  knowl- 
edge, should  be  the  foundation  stones  of  medical  education. 

With  regard  to  technique,  the  development  of  recent 
years  has  been  marked  and  of  the  utmost  value.  With  re- 
gard to  application,  the  tendency  toward  thorough  com- 
pulsory hospital  and  dispensary  experience  is  sound  and 
progressive.  With  regard  to  pedagogic  philosophy,  look- 
ing to  inculcation  of  principles,  the  situation  is  not  so 
satisfactory. 

A  tendency  toward  laboratory  development  has  drawn 
us  away  from  the  more  deeply  cultural  aspects  of  medicine. 
In  two  directions,  notably,  medical  curricula  are  deficient. 
Speaking  broadly,  there  is  no  education  offered  to  medical 
students  in  the  fundamentals  of  hygiene  and  psycholog^^ 

Any  experienced  practitioner  whose  perspective  corres- 
ponds to  his  experience  wdll  recognize  the  w^eakness  in  this 
situation.  In  part  this  omission  is  due  to  the  flood  of  mater- 
ial which  has  seemed  to  demand  recognition  in  the  curricu- 
lum. In  part  it  is  due  to  an  intense  demand  for  scientific 
training  which  in  recent  years  has  dominated  the  profession 
and  which  has  resulted  not  only  in  the  overcrowding  of  the 
student  mind,  but  in  noticeable  minimizing  of  the  practi- 
tioner aspect  of  the  graduate. 

If  one  could  assume  that  matters  of  sanitation,  personal 


432  HENRY     BAIRD     FAVILL 

hygiene,  and  psychology  could  be  left  to  specialists,  the 
existing  policy  could  be  defended  and  special  instruction 
afforded.  Such  an  assumption,  however,  is  not  sound,  and 
unless  we  are  to  trust  to  years  of  blunder  and  struggle  to 
drive  home  to  our  medical  men  their  ignorance  and  inefifi- 
ciency,  we  must  do  better  with  primary  education.  Either 
it  is  to  be  satisfied  to  have  the  well-trained  young  medical 
man  furnish  his  purely  scientific  contribution,  relying  upon 
some  intermediate  functionary  to  make  this  effective,  or  he 
must  be  equipped  in  such  a  way  as  to  connect  his  science  with 
his  practice  in  a  more  comprehensive  way. 

I  dwell  upon  this  with  greater  emphasis  because  I  believe 
the  truth  is  not  realized  by  leaders  in  professional  thought 
and  method.  It  is  because  the  regular  medical  profession 
has  been  truly  deficient  and  in  error  in  the  various  ways 
which  I  have  hitherto  discussed,  that  the  world  is  so  full  of 
isms,  pathys,  and  pseudo  philosophies  in  medical  affairs. 
We  are  responsible  by  default  for  most  of  the  fantastic 
therapeutic  heresies  that  pervade  society  to-day. 

I  have  taken  your  time  thus  far  to  discuss,  as  I  believe 
fairly,  the  faults  of  the  medical  profession.  Fortunately  I 
am  not  gifted  with  powers  of  invective  and  craving  to  exploit 
them,  which  lead  persons  of  supposed  authority  and  inside 
knowledge  into  scathing  and  scornful  abuse.  Nothing  is 
to  be  gained  by  that  kind  of  discussion.  "Exposure"  of  the 
faults  of  the  medical  profession,  breaking  forth  from  time  to 
time,  accomplishes  nothing  except  notoriety  to  the  author 
of  the  attack.  Fair  admission  of  the  facts  as  they  are  and 
analysis  as  to  their  true  explanation  are  certainly  worth  our 
while. 

I  have  said  nothing  nor  do  I  care  to  say  much  about  the 
pecuniary  aspects  of  our  problems.  That  there  are  abuses 
in  this  field  is  beyond  question.  That  professional  dis- 
honesties can  be  made  the  basis  for  pecuniary  gain  goes 
without  saying.  That  there  is  room  for  review  in  the  com- 
pensation of  medical  men  is  distressingly  evident.     These 


MEDICI  NI<:      AND      IMIU.  IC      11  I-:  A  I.  I   II  433 

things,  however,  are  not  riindamenta]  to  the  integrity  of 
the  relationship  of  the  profession  to  the  [nihlie,  but  will 
adjust  themselves  on  a  basis  of  commereial  integrity,  finally. 
It  is  a  topie  too  large  and  important  to  be  dealt  with  in  a 
paragraph.  There  is  fully  as  mueh  room  for  solicitude  that 
medical  men  in  general  be  not  underpaid  as  that  a  few 
individuals  be  not  overpaid.  These  questions  arc  impor- 
tant but  are  not  as  basic  as  I  think  are  the  phases  which  1 
have  discussed. 

With  all  qualifications  which  may  be  made  as  to  present 
value  of  the  service  rendered  by  the  medical  profession,  and 
unconfused  by  reservations  which  are  an  inevitable  conse- 
quence, the  prime  question  in  the  whole  matter,  I  repeat,  is, 
What  are  the  values  in  medical  science? 

The  more  thoroughly  human  affairs  are  investigated, 
the  more  the  underlying  causes  for  social  conditions  are 
discovered,  the  deeper  a  knowledge  of  social  pathology  be- 
comes, the  more  manifest  it  becomes  that  mental,  moral,  and 
physical  values  in  human  affairs  are  ultimately  questions 
of  health.  From  the  vague,  intangible,  and  unorganized 
but  deeply  impressive  facts  of  heredity,  on  through  the 
intricacies  of  the  philosophy  of  environment,  and  on  again 
through  the  currents  and  counter-currents  of  social  devel- 
opment, all  inextricably  interwoven  and  interdependent, 
there  shows  forth  with  increasing  clearness  and  irresistible 
conviction  a  picture  of  a  world  proceeding  towards  its  des- 
tiny, safeguarded  only  to  the  degree  that  it  is  sane  and 
sound. 

It  is  to  these  factors  of  sanity  and  physical  soundness 
that  medical  science  addresses  itself.  In  no  field  of  human 
endeavor  is  there  so  much  earnest,  self-sacrificing,  truth- 
seeking  and  truth-demanding  labor,  as  is  to  be  found  in  the 
workers  in  medical  science.  Their  standards  are  high,  their 
criticism  profound,  their  patience  inexhaustible.  Year 
after  year,  decade  after  decade,  they  are  delving  into  the 
obscurit}^  of  life  phenomena,  and  encouraged  by  ever}-  detail 


434  HENRY     BAIRD     FA  V  ILL 

of  discovery  are  undaunted  by  floods  of  disappointment 
arising  from  inherent  difficulties  in  their  task. 

Medical  science  knows  no  country,  no  creed,  no  politics, 
and,  in  general,  no  personal  advantage.  The  underlying 
motive  is  truth  which  may  be  applied  to  the  benefit  of  man- 
kind. Whatever  the  off-shoots  from  this  development,  it 
must  be  recognized  that  the  fundamental  purpose  is  honest, 
dignified,  and  indispensable. 

The  detachment  of  workers  in  pure  science  from  the 
practical  affairs  of  life  necessitates  bridging  a  gap  by  efforts 
of  medical  practitioners.  Not  less  than  to  the  master 
minds  of  research  must  we  give  recognition  to  men  and 
women  who  are  on  the  firing  line. 

It  is  true  that  the  resources  of  medical  knowledge  are  not 
as  yet  fully  available  for  the  public  weal.  This  is,  however, 
in  no  sense  a  reproach  to  the  medical  profession  but  is  dis- 
tinctly a  defect  of  social  organization.  For  the  rich,  all 
possible  resources  of  material  character  are  available.  For 
the  very  poor,  all  such  resources  relating  to  immediate  treat- 
ment of  disease  of  a  type  grave  enough  for  hospital  care 
are  freely  available,  but  for  the  great  mass  of  people  neither 
rich  nor  paupers,  to  whom  the  factor  of  cost  is  a  vital  con- 
sideration, the  resources  of  medicine  are  available  in  but  a 
fragmentary  degree. 

It  is  in  this  field  that  the  practicing  profession  meets 
with  its  most  serious  handicap.  No  matter  how  keenly  a 
physician  may  discern  the  outlying  factors  in  his  experi- 
ence, no  matter  how  deeply  conscious  he  may  be  that  the 
root  of  the  conditions  he  deals  with  lie  far  below  the  surface 
of  his  problem,  he  is  face  to  face  with  conditions  of  social 
mal-organization  that  render  his  utmost  contribution  dis- 
couraging and  futile.  Is  it  any  wonder,  under  these  circum- 
stances, that  his  work  is  in  places  superficial?  Nevertheless, 
justice  demands  that  he  be  given  the  fullest  measure  of 
credit  for  patient,  persistent,  and  intelligent  effort  to  over- 
come these  difficulties  as  best  he  may. 


M  1<:  IM  C  I  N  I<:      AND      IM;|{LI(       If  j;  ALT  If  435 

Wc  arc  prone  to  discuss  medical  matters  from  the  stand- 
])oint  of  ilieir  elaborate  and  conspicuous  episodes  amongst 
the  well-to-do  or  from  the  brilliant  and  well  coordinated  ac- 
tivities of  hospital  life.  It  must  be  borne  in  mind  that  the 
mass  of  medical  experience  lies  amongst  the  working  people. 
It  is  here  that  economic  aspects  of  health  problems  become 
so  pronounced.  In  social  affairs  we  are  prone  to  consider 
people  from  the  standpoint  of  dependence  or  independence. 
In  medical  afifairs  the  classification  and  definition  fails.  PVjr 
the  average  man  who  is  a  wage-earner,  the  question  as  to 
his  dependence  practically  turns  upon  his  ability  to  go  to 
work  to-morrow  morning.  Whatever  devices  may  have 
been  developed  for  meeting  the  situation,  that  is  the  bald 
truth  in  the  matter.  Practitioners  of  medicine  recognize 
this  and  have  it  to  deal  with  as  have  no  other  class  of 
citizens. 

From  an  economic  standpoint  all  classes  of  citizens  taken 
together  render  less  substantial  aid  in  meeting  this  situation 
than  is  rendered  daily,  weekly,  and  perennially  by  the  rank 
and  file  of  the  medical  profession. 

A  physician  has  in  his  clientele  an  industrious,  self- 
respecting  family.  They  run  on  comfortably,  seeking  his 
aid  and  paying  their  bills,  maintaining  a  normal  relationship. 
Some  disaster  of  ill-health  overtakes  the  breadwinner  of  the 
family.  In  a  flash  they  are  transferred  into  a  position  more 
or  less  dependent,  and  are  unable  to  pay. 

The  one  individual  in  the  community  from  that  time 
forth,  who  carries  that  load  without  compensation  and  with- 
out murmur,  is  the  doctor,  and  these  experiences  are  occur- 
ring daily,  and  by  the  hundred  thousands.  Trv-^  to  picture 
all  that  that  means  in  those  distressing  circumstances? 
Does  it  make  the  story  of  the  doctor  of  the  old  school  some- 
thing to  be  cast  aside  as  outgrown,  or  does  it  leave  it  as  one 
of  the  great  fundamental  human  facts?*  But  in  so  far  as 
there  exists  this  value,  is  it  an}^  less  than  fair  that  the 
judgment  of  the  public  upon  the  medical  profession  shall  be 


436  HENRY     BAIRD     FA  V  ILL 

exercised  with  true  vision  as  to  the  real  contribution  that 
it  makes? 

These  are  aspects  of  conventional  and  time  honored 
practice  of  medicine  to  which  I  have  wanted  to  call  your 
attention.  There  remains  another  aspect  in  which  is  pre- 
sented the  great  field  of  future  activities  for  the  profession. 

The  general  subject  of  public  health,  in  spite  of  its  tre- 
mendous development  in  recent  years,  has  not  been  prop- 
erly coordinated  with  the  medical  profession.  In  spite  of 
the  fact  that  the  initiative  and  insight  in  public  health  mat- 
ters have  come  primarily  from  physicians,  there  exist  two 
fundamental  defects  in  organization  and  development  of 
the  enterprise. 

The  public  has  never  intelligently  estimated  nor  fairly 
measured  the  contribution  to  public  welfare  embodied  in 
the  labor  of  the  enlightened  physicians  who  stood  behind 
the  move.  The  rule  is  that  any  measure  of  importance 
dealing  with  health  advancement,  particularly  through 
legislative  measures,  has  been  met  with  indifference,  dis- 
credit, or  active  opposition  from  large  groups  of  citizens. 
The  basis  of  opposition  has  varied.  As  a  rule,  selfish  inter- 
ests have  organized  opposition.  Frequently  they  have  been 
able,  through  skillful  manipulation  and  adroit  play  upon  the 
prejudice  of  the  public,  to  muster  formidable  forces  from  the 
ranks  of  people  who  are  not  selfish  in  the  matter  but  who  are 
ignorant  of  its  true  bearings,  and  upon  various  fallacious 
hypotheses  suspect  an  invasion  of  their  rights.  Although 
doubtless,  here  and  there,  measures  have  been  proposed  by 
physicians  who  are  not  clearly  disinterested,  in  an  enormous 
preponderance  of  instances  self-interest  has  played  not  the 
slightest  part.  Although  an  occasional  opposition  to  public 
health  movements  has  been  honest  and  without  sinister 
purpose,  in  an  the  great  majority  of  cases  selfish  motives, 
resting  upon  vicious  public  policy,  have  initiated  and 
manipulated  the  battle. 

I  know  of  no  department  of  social  effort  in  which  the 


M  K  I)  I  C  F  N  !<:      AN  I)      I'  (J  I'.  L  I  C      II  I-;  A  \.  l   W  437 

underlyinjj;  motive  in  proinotin}.^  pnhlic  legislation  has  been 
so  altruistic  on  the  part  of  its  sponsors.  I  know  of  no  field 
in  whieh  the  basis  of  opposition,  when  traced  to  its  root, 
has  been  so  sinister.  The  public  does  not  see  clearly  what 
is  at  stake.  When  it  does,  the  difficulties  upon  this  score 
will  melt  away.  It  is  as  true  in  this  direction  as  in  others, 
that  public  sentiment  must  move  reasonably  abreast  of 
legal  enactment.  The  ])atli  before  the  medical  profession 
is  clearly  and  simply  education  of  the  public. 

This  brings  us  face  to  face  with  the  second  defect  in 
development.  Agitation  of  public  health  matters  has  been 
markedly  an  individual  matter.  The  rank  and  file  of  phy- 
sicians have  exhibited  the  same  indifference,  a  large  measure 
of  unintelligence,  and  occasional  misguided  opposition  to 
progress  in  this  line.  These  facts  are  vital  to  the  whole 
matter;  until  the  profession  as  a  whole  can  consider  itself 
an  instructor  of  the  people,  progress  will  be  slow  and  frag- 
mentary. The  prime  requisite  in  furthering  the  purposes 
of  public  benefit  must  be  confidence  on  the  part  of  the  public 
as  to  the  disinterestedness  of  the  profession  in  the  matters 
which  it  projects. 

Although  as  a  rule  there  has  been  small  basis  for  doubt 
upon  this  point,  here  and  there  utterances  and  movements 
are  in  evidence  which  have  neither  intelligence  nor  respon- 
sibility behind  them.  Once  in  a  while  we  hear,  from  the 
proponents  of  legislation,  arguments  so  trivial,  so  selfish, 
so  shortsighted  as  to  be  unworthy  of  serious  consideration. 
Nobody  who  knows  the  truth  regards  them  seriousty. 

On  the  other  hand,  they  furnish  ammunition  for  forces 
in  opposition,  and  from  time  to  time  we  are  confronted  by 
utterances  ostensibty  representative  of  our  professional 
attitude  which  could  have  emanated  only  from  fools. 
Our  great  difficulty  within  the  ranks  is  failure  to  realize  the 
paramount  importance  of  the  issue  and  the  inevitable  trend 
of  human  events.  Failing  in  this,  indifference  becomes  an 
almost  crushing  load,  which  has  to  be  lifted  before  any  real 


438  HENRY     BAIRD     FAVILL 

advance  can  be  made.  It  is  by  stimulating  ourselves  to 
become  intelligent  leaders  of  the  people  that  we  can  most 
contribute  to  the  public  weal. 

Although  development  of  public  health  interests  can  go 
on  in  a  measure  mthout  us,  it  can  never  reach  its  full  measure 
of  strength  and  beneficence  except  upon  the  foundation  of 
our  generalized  contribution. 

In  the  meantime  conditions  underlying  final  organization 
looking  to  safeguarding  the  health  of  the  race  are  gradually 
being  adjusted.  Recognition  of  the  fact  that  industry  is  in 
the  last  analysis  a  matter  of  health  is  widespread.  All  of  the 
great  questions  related  to  the  well-being  of  the  masses  in 
their  work,  their  play,  their  opportunities,  their  habitations, 
their  livelihood,  their  infancy,  and  their  old  age,  correlate 
absolutely  in  the  one  great  factor  of  health. 

Our  public  health  departments,  medical  schools,  labor- 
atories of  research,  our  scrutiny  of  industry,  safeguarding  of 
schools,  are  contributing  each  in  its  field  to  the  vast  array 
of  fact,  upon  which  will  ultimately  be  founded  an  intelligent 
structure  of  systematic  living.  Beyond  any  question,  how- 
ever, an  interpretation  of  this  gospel  must  finally  rest  with 
the  medical  profession.  Interpretation,  however,  is  but  the 
first  word  in  progress.  The  last  word  is  cooperation  of  the 
public,  induced  by  every  available  activity  in  education. 

The  greatest  obstacle  to  cooperation  invariably  is  dis- 
trust. The  greatest  incentive  to  cooperation  is  recognition 
of  community  of  interest  and  confidence.  I  stand  here  to- 
night arguing  for  the  former  and  pleading  for  the  latter; 
"By  their  fruits,  ye  shall  know  them."  Gladly  submitting 
to  that  judgment,  the  medical  profession  demands,  as  it 
acknowledges  it  owes,  a  square  deal;  that  it  be  not  loaded 
with  unjust  or  illogical  responsibilities,  nor  judged  by  vicious 
and  perverted  standards,  but,  in  so  far  as  it  brings  to  bear 
upon  questions  of  public  welfare,  intelhgent,  scientific, 
and  disinterested  effort,  it  shall  be  accorded,  on  the  part  of 
the  public,  cooperation.     It  asks  no  more. 


II.     AGRICULTURE   AND    DAIRYING 


11.     AGRICULTURE   AND    DAIRYING 

Delivered  before  the  Holstein-Freisian   Association,   Syracuse,    N.  Y., 

jniic  7,    Kji  I . 
Printed,  Breeder's  Gdzcllr,  June  14,  \<)i\. 

TUBERCULOSIS    IN    CAT'I1>E 

WHEN  1  was  invited  by  your  president  to  deliver  this 
address,  I  was  conscious  of  some  hesitation  in  doing 
what  I  was  in  fact  very  anxious  to  do. 

The  question  came  to  me,  fully  as  sharply  as  it  can  have 
come  to  you,  as  to  what  right  I  had,  with  my  limited  experience 
in  breeding  cattle,  to  take  the  time  of  past  masters  in  the 
art,  in  the  discussion  of  its  most  difficult  question.  Further 
reflection,  however,  led  me  to  see  that  in  practical  dealing 
with  Tuberculosis,  there  are  no  past  masters,  and  that  a 
life-long  study  of  it  as  a  daily  problem,  even  though  not  as 
related  to  cattle,  entitled  me  to  opinions  that  I  would  like 
to  share  with  men  with  whom  I  have  a  common  interest. 
Moreover,  I  have  been  in  close  relation  to  the  American 
work  directed  to  the  control  of  tuberculosis  in  the  masses, 
and  hence  have  gotten  in  full  the  bias  and  the  point  of  view 
of  those  who  approach  the  problem  of  tuberculosis  in  ani- 
mals, from  the  side  of  human  relations.  If,  therefore,  I 
differ  from  much  that  exists  to-day  upon  that  side  of  the 
question,  it  is  not  a  partisan  differing,  but  the  gradual  growth 
of  a  fuller  understanding  of  the  subject. 

Primarily,  let  me  say  that  there  can  be  no  conflict  be- 
tween the  real  interest  of  the  cattle  industr}^  and  the  real 
health  interest  of  the  Public.  Where  they  clash,  misunder- 
standing, misinterpretation,  and  bad  judgment  are  to  blame. 

The  cattle  industr\^  exists  for  the  benefit  of  the  human 
race,  and  for  no  other  reason,  and  it  is  absurd  to  admit  a 
conflict.  This  unquestionable  fact  makes  it  imperative 
that  whatever  is  done  for  the  advancement  of  cattle  shall 
have  in  view  also  human  welfare,  but  it  makes  it  more 
imperative  that  what  is  undertaken  for  some  obvious  need 

441 


442  HENRY     B  A  I  R  D     F  A  V  I  L  L 

of  people  shall  not  be  so  imperfect  and  limited  in  its  effect 
as  to  damage  an  industry  which  is  fundamental,  so  far  as 
we  now  see,  to  human  existence. 

The  great  danger  in  the  active  work  of  regulation  and 
protection  that  is  going  on  over  the  country  to-day,  is  fail- 
ure of  the  proponents  of  legislation  to  view  the  matter  in 
all  of  its  bearings. 

It  is  about  legislation  that  the  battle  is  fought;  so  fool- 
ishly but  generally  regarded,  as  the  farmers  against  the  peo- 
ple. It  is  the  old  story  of  a  party  having  rights  but  no 
practical  knowledge,  in  a  struggle  with  a  party  having  also 
rights  but  in  addition  the  deepest  practical  experience. 

The  tendency  of  the  party  with  experience  is  to  scorn 
the  views  of  the  inexperienced.  The  tendency  of  those 
who  claim  their  rights,  though  acknowledging  their  ignor- 
ance, is  to  question  the  motives  of  the  antagonists.  Both 
are  wrong,  and  there  is  no  greater  opportunity  for  states- 
men to-day,  than  to  get  them  together. 

As  I  see  it,  the  greatest  need  now  is  clearly  to  define 
the  issue.  Up  to  this  time,  legislative  enactments  con- 
cerning dairy  cattle  have  been  based  upon  two  proposi- 
tions: first,  that  tubeiculous  cattle  produce  milk  con- 
taining tuberculosis  germs;  second,  that  such  milk  is 
harmful  to  human  beings. 

Are  these  two  propositions  sound?  There  is  no  doubt 
that  a  tubercular  cow  may  produce  milk  that  contains  no 
germs  of  tuberculosis,  in  fact,  that  the  great  majority  of 
infected  cows  do  produce  at  the  udder  milk  free  from  such 
germs.  Yet  the  fact  is,  that  the  dairy  product  of  such  a 
cow  is  likely  to  be  infected  by  contamination  from  herself  or 
from  her  infected  neighbor.  It  is  therefore  true  that  the 
milk  of  an  infected  dairy  is  sure  at  times  to  be  the  bearer 
of  the  germs  of  tuberculosis.  Hence,  the  first  proposition 
cannot  be  gainsaid. 

How  then,  the  second?  Is  milk  containing  the  germs 
of  tuberculosis  harmful  to  human  beings  ? 


A  ( i  K  I  r  I J  r.  T  U  R  E     AND     I)  A  I  R  V  I  N  f  i  443 

Yoii  kiif»w  llic  conflict  .'imon^'  scientists  that  has  been 
waj^c(l  ii])on  tJi.'il  (|ucsiion.  Oradually  hght  has  come  out 
of  the  darkness,  and  it  is  now  the  prcvaih'ng  opinion,  which 
I  share,  that  to  a  hmited  extent  certainly,  and  perhai>s  to 
a  great  extent,  bovine  tuberculosis  is  transmitted  to  human 
beings  in  milk,  producing  disease  which,  if  not  identical  with 
human  tuberculosis,  is  none  the  less  progressive,  destructive 
disease.  No  matter  how  little,  no  matter  how  different,  if 
this  be  true,  it  is  a  legitimate  subject  of  consideration  from 
the  stand])oint  of  human  welfare.  The  more  it  is  related  to 
children  and  loabies,  the  more  obligation  to  meet  it. 

Here,  then,  is  the  crucial  point:  Is  the  attention  that  is 
turned  to  this  subject  in  the  interest  of  human  health  based 
upon  a  clear  conception  of  the  foregoing  facts  ?  Let  us  make 
the  answer  clear.     It  is  not. 

The  fear  of  tuberculous  milk,  now  generally  entertained 
by  the  public,  is  based  upon  what  now  seems  a  misconcep- 
tion. To  the  general  public,  tuberculosis  means  consump- 
tion, that  unspeakably  dreadful  scourge  of  the  world.  The 
idea  that  milk  is  a  large  factor  in  producing  consumption  of 
the  lungs,  which  prevailed  a  few  years  ago  among  scientists, 
prevails  to-day  among  the  people.  Naturally  the  prejudice 
upon  that  basis  is  very  deep.  Legislation  and  regulation 
started  under  that  belief.  Promoters  of  health  legislation 
have  urged  the  human  susceptibility  to  tuberculosis  to  the 
full  as  a  pressure  to  secure  protection.  The  result  is  that 
the  public,  believing  something  that  is  way  beyond  the 
proven  truth,  has  one  point  of  view.  The  milk  interests, 
being  much  more  closely  informed  as  to  these  facts,  if  they 
wish  to  be,  either  stand  upon  these  facts  or,  repudiating 
them  entirely,  have  quite  another  point  of  view.  There  is 
consequently  no  sympathy  in  the  situation.  The  pubHc,  in 
demanding  what  it  has  a  right  to,  enormously  over-states 
the  dangers.  The  dairymen,  knowing  this,  and  knowing 
also  the  enormous  difftculties  in  the  practical  solution, 
fight  as   though   fighting  for  their  existence. 


444  HENRY     BAIRD     FAVILL 

The  people  majestically  wave  the  wand  and  say,  eradi- 
cate tuberculosis.  The  farmer,  whether  he  knows  enough 
to  want  to  be  free  or  not,  knows,  by  dire  experience,  that 
rough-shod  and  inefficient  ways  of  going  at  it  bring  ruin 
and  no  results.  Naturally,  even  if  stupidly,  he  shows  a 
sullen  resistance.  He  knows  that  dishonesty,  incompe- 
tency, and  empiricism  have  marked  the  progress  of  this 
crusade,  and  he  fears  the  cogs  of  government  that  is  not 
wisely  and  honestly  administered. 

All  this  may  be,  and  still  the  purpose  of  the  two  sides 
may  be  sincere.  But  there  is  an  element  far  worse  in  it. 
The  question  has  got  into  politics.  If  I  could  paint  you  a 
picture  I  have  in  mind,  no  words  would  be  needed. 

At  a  late  meeting  of  the  committee  having  to  do  with 
agriculture  and  dairy  interests  of  the  Illinois  Legislature,  the 
question  was  up  whether  the  committee  report  out  for  pass- 
age a  bill  requiring  that  cattle  shipped  into  the  State  be 
tuberculin  tested.  The  bill  was  known  as  the  "Fence  Bill." 
The  meeting  was  addressed  by  the  spokesman  for  a  group 
of  retail  milk  producers  there  present.  The  committee, 
about  to  report  the  bill  favorably,  was  represented  by  one 
of  its  prominent  members  as  spokesman.  The  arguments 
against  the  bill,  lasting  several  hours,  in  epitome  were: 

1.  That  there  is  no  such  thing  as  tuberculosis  that 
harms  cattle. 

2.  That  there  is  far  less  of  it  than  there  used  to  be. 

3.  That  a  man  can  tell  it  by  examination,  if  it  exists. 

4.  That  it  does  no  harm  anyway. 

5.  That  tuberculin  will  not  detect  it. 

6.  That  tuberculin  will  induce  it. 

7.  That  mistakes  occur. 

8.  That  it  is  dishonestly  done. 

9.  That  the  whole  agitation  is  in  the  interest  of  veteri- 
narians and  officials  who  want  jobs. 

To  all  this,  the  committee,  through  one  of  its  members, 
replied.     Now  note  the  tone  of  the  answers: 


AGRIC'.ULTU  K  K      AND     DAIRYING  445 

"I  don't  believe  in  tlie  hill.  !  believe  the  tuberculin  test- 
ing is  nonsense  as  much  as  you  do,  but  Wisconsin  has  a  law 
so  stringent  that  it  is  said  that  Illinois  will  be  a  'dump- 
ing ground '  for  infected  cattle ;  moreover,  we  are  reporting 
for  passage  a  bill  prolTibitin;.,^  municipalities  from  making 
ordinances  that  will  discriminate  against  tuberculous  milk, 
and  we  have  to  pass  this  law  as  a  concession  to  get  that 
law  passed,  for  that  is  the  way  legislation  is  done."  The 
latter  law  proposed,  be  it  said,  was  an  outgrowth  of  a 
personal  fight  in  Chicago. 

Hence,  on  this  economic  question,  a  law  was  recom- 
mended not  with  the  least  belief  in  its  merits,  but  as  a  make- 
weight in  the  waging  of  a  battle  of  local  and  factional 
character  in  the  politics  of  a  big  city.  When  you  add  to 
the  normal  clash  of  opinions  and  interests  amongst  honest 
people  this  mixture  of  ignorance,  misstatement,  selfish  in- 
terest, and  political  maneuvering,  is  it  any  wonder  that  we 
are  getting  nowhere  either  in  harmony  or  results? 

But  this  situation  is  not  hopeless.  There  stands  be- 
tween these  two  factions  another  class  of  men,  for  the  most 
part  breeders,  who  recognize  this  great  truth.  Tuberculosis 
in  dairy  cattle  is  not  a  baby  question,  it  is  a  cow  question. 
Until  that  is  recognized  by  the  many  as  fully  as  by  the  few, 
the  subject  will  remain  in  its  present  confusion  and  odium. 

The  proposition  is  simple.  Is  tuberculosis  a  menace  to 
the  cattle  industry?  That  question  can  be  met,  discussed, 
demonstrated,  and  measured  without  conflict  or  ill  feeling. 
But  I  am  convinced  that  any  substantial  progress  in  eradi- 
cating the  disease  must  be  made  upon  the  line  of  the  intrin- 
sic interest  of  the  industr}^  and  not  upon  some  outside  issue, 
no  matter  how  important  in  itself. 

Many  men  who,  like  me,  are  active  in  the  work  of  com- 
batting human  tuberculosis,  are  of  this  opinion.  Without 
criticising  the  purpose  of  health  legislation  upon  this  point, 
I  am  convinced  that,  in  the  effort  to  eradicate  the  disease 
in  cattle,  it  is  ineffective,  and  so  far  as  it  is  the  course  of 


446  HENRY     BAIRD     FA  V  ILL 

bitterness  and  controversy,  it  actually  retards  the  develop- 
ment of  sound  opinion. 

In  support  of  this  I  call  you  to  witness  that  the  active 
opponents  of  tuberculosis  legislation  make  this  fight  mostly 
upon  the  question  of  danger  to  human  beings,  and  rarely 
discuss  the  prospects  of  the  industry. 

I  am  not  going  to  stop  to  discuss  with  an  audience  like 
this  the  question  as  to  whether  it  is  a  menace.  I  assume 
that  we  are  agreed: 

1.  That  tuberculosis  is  a  contagious  disease. 

2.  That  if  no  measures  are  taken  to  prevent  it,  all 
animals  closely  in  contact  with  diseased  individuals  are 
liable  to  it,  and  none  are  immune. 

3.  That  sooner  or  later  a  percentage  of  animals  that 
become  infected  become  worthless. 

4.  That  any  animal  so  infected  may  become  a  source 
of  danger  to  the  herd. 

It  is  not  enough  that  such  men  as  are  here  gathered 
should  believe  this.  Understanding  and  belief  in  these 
truths  must  be  practically  universal  before  the  cattle  world 
is  in  position  to  advance  far. 

The  breeders  and  especially  enlightened  individuals  are 
a  small  minority.  There  are  hundreds  of  thousands  of 
owners  of  cattle  who  are  producing  and  distributing  disease, 
and  they  must  be  convinced. 

And  why,  we  may  ask,  is  it  so  difficult  to  convince  them? 

Why  shouldn't  it  be  difficult?  The  cow  that  goes  to 
the  end  of  her  disease,  where  she  becomes  worthless, 
obviously  in  consequence  of  tuberculosis,  is  the  exception. 
Before  that  period,  she  is  sold  or  slaughtered  and  the 
object  lesson  is  lost. 

What  farmers  are  shown  is  the  mass  of  cattle,  most  of 
them  in  apparent  health,  which  "react,"  and  they  see,  if 
they  follow  them  to  slaughter,  a  majority  of  cases  in  which 
the  disease  is  apparently  insignificant  and  sometimes  quite 
absent. 


A(;  RI  (•  U  LT  U  R  P:     and     F)ArKYING  447 

Let  us  (Ir.'iw  :i  p.-Lnilld  in  liuiiiaii  affairs.  Suppose  that 
very  few  people  ever  died  of  consumption  but  were  carried 
off  by  some  other  process  before  their  disease  was  very 
evident.  Suppose,  in  addition  to  that,  that  all  people  were 
subjected  to  tuberculin  test,  and  it  were  found,  as  it  would 
be,  that  somewhere  from  60  to  90  per  cent  reacted  at  some- 
time or  other  in  life,  and  that  of  these  a  large  percentage 
yet  recovered;  would  it  not  be  infinitely  difficult,  in  the  ab- 
sence of  death  from  the  disease,  to  impress  the  public  with 
its  gravity? 

Well,  the  situation  with  the  owners  of  cattle  is  like  that, 
and  in  addition  they  are  alienated  by  the  predominance  of 
considerations  that  they  regard  as  spurious. 

No  one  who  has  not  struggled  with  the  problem  of  try- 
ing to  persuade  human  beings  of  the  importance  of  human 
tuberculosis, — those  whose  lives  are  at  stake, — is  in  posi- 
tion to  realize  the  enormous  difficulties  involved  in  bringing 
to  that  point  of  intelligence  the  mass  of  owners  of  cattle 
as  to  bovine  tuberculosis.  To  this  end  every  legitimate 
agency  will  need  to  be  taxed  to  its  utmost,  and  the  struggle 
is  not  one  of  years,  but  of  decades  and  perhaps  of  genera- 
tions, and  yet  this  struggle  must  be  made. 

Practical  experience  is  eloquent  enough  upon  this  sub- 
ject, but  scientific  training  adds  greatly  to  a  grasp  of  the 
specific  dangers  and  difficulties  involved.  If  the  veteri- 
naries  are  especially  active  in  urging  preventive  measures, 
it  is  because  of  their  especially  trained  faculties  and  not 
because  of  self-interest. 

It  is  naturally  very  hard  to  persuade  a  layman  who  has 
no  clear  comprehension  of  the  qualities  and  behavior  of 
disease  germs,  that  a  cow  in  apparent  health  and  with  full 
performing  capacity  can  be  spreading  the  germs  of  infection 
in  the  most  prodigal  way.  Nevertheless  this  is  true,  and 
until  this  truth  can  be  hammered  home  in  such  a  way  as  to 
make  it  a  matter  of  conviction  to  all,  these  dangers  can 
not  be  eliminated. 


448  HENRY     BAIRDFAVILL 

There  is  great  obscurity  in  the  minds  of  most  people 
as  to  the  methods  by  which  the  disease  is  spread.  Careful 
experiment  shows  beyond  doubt  that  far  and  away  the 
most  important  path  of  contagion  is  through  droppings 
of  diseased  cattle. 

On  the  face  of  it  this  suggests  two  facts :  First,  that  tu- 
berculosis will  be  spread  enormously  amongst  such  animals 
as  follow  cattle,  in  particular  hogs.  Second,  that  it  renders 
especially  vulnerable  all  animals  susceptible  to  tuberculosis 
that  are  fed  upon  milk,  which  is  contaminated  unavoid- 
ably by  the  fecal  material  from  diseased  cattle.  Here  at 
once  opens  the  question  of  the  feeding  of  calves.  Beyond 
doubt,  calves  are,  by  reason  of  their  age  and  immaturity, 
particularly  susceptible  to  tuberculosis.  They  are  fed 
largely  upon  milk  and  experiment  has  shown  that  calves 
fed  upon  tuberculous  milk  are  liable  to  acquire  tubercu- 
losis. Why,  under  existing  conditions,  it  is  not  more  inevit- 
able is  a  problem. 

There  can  be  but  one  conclusion  to  draw,  namely,  that 
all  possible  precaution  against  feeding  calves  tuberculous 
milk  is  the  part  of  wisdom.  In  itself,  this  is  a  matter 
entirely  possible  to  accomplish,  and  the  attention  of  cattle 
breeders  should  be  directed  with  the  utmost  emphasis 
toward  providing  for  young  stock  milk  which  is  not  so 
contaminated.  When  this  is  effectively  done,  a  very  great 
advance  will  have  been  made. 

There  remains,  however,  to  be  considered,  the  methods 
by  which  mature  cattle  acquire  disease  one  from  another. 
Upon  this  point  there  is  considerable  obscurity.  Observa- 
tion has  shown,  however,  that  the  saliva  of  certain  of  the 
infected  cattle  carries  the  infection.  This  means  that  the 
muzzles  are  more  or  less  the  point  of  contact,  and  of  course 
this  opens  up  the  question  of  stable  infection  and  all  its 
difficulties.  The  probability  is,  the  danger  from  the  mouth 
and  muzzle  of  the  cow  is  not  nearly  so  great  as  that  from 
the  feces.     This,  doubtless,  in  a  large  measure  accounts  for 


A  (i  K  I  C  ULTUK  1-:      AND     I)  A  I  K  Y  I  N  (i  449 

the  fact  that  the  disease  does  not  spread  more  rapidly  than 
it  does  amongst  the  adults;  but  that  it  does  spread  gradually 
throughout  the  herd,  if  unrestricted,  there  is  no  possible 
question. 

It  would,  ])erhaps,  be  less  difficult  to  bring  firm  convic- 
tion home  to  the  farmer  as  to  these  questions  if  we  were  in 
a  position  to  offer  a  clear  line  of  procedure  which  affords 
a  distinct  way  out  of  the  difificulty.  In  fact,  if  there  is 
nothing  to  do  about  it  there  is  no  practical  use  in  bringing 
about  such  conviction. 

When  we  undertake  to  discuss  remedies  it  is  of  the  ut- 
most importance  that  we  discuss  practical  remedies.  The 
commonest  comment  that  one  hears  runs  like  this:  "Oh, 
yes,  so  and  so  has  plenty  of  money,  runs  his  farm  as  a 
fancier,  and  can  afford  to  test  and  slaughter  as  often  and 
as  much  as  he  chooses."  Testing  and  slaughtering  to  the 
average  farmer  seems  like  a  ruinous  business  and  often  is, 
and  it  is  true  that  if  all  tubercular  cattle  could  be  slaughtered 
forthwith,  not  only  would  the  result  upon  the  milk  supply 
of  the  world  be  disastrous,  but  the  disease  would  within  a 
short  time  be  just  as  prevalent  as  before,  unless  the  process 
were  rigidly  followed  up. 

Some  plan  of  action  has  got  to  come  into  vogue  whereby 
as  a  common  and  recognized  practice  herds  shall  more  or 
less  automatically  be  protected  by  current  methods. 

Are  such  methods  possible  and  practical?  Let  us  again 
seek  an  analogy  in  the  experience  with  human  tuberculosis. 
There  exist  in  the  United  States  to-day  upwards  of  five 
hundred  separate  organizations  created  for  the  purpose  of 
combatting  tuberculosis.  For  the  most  part  the  efforts  of 
these  bodies  have  been  directed,  first,  toward  detecting 
early  cases;  second,  toward  curing  early  cases,  which  alone 
are  curable;  third,  toward  establishing  better  living  con- 
ditions for  the  masses;  and  fourth,  but  almost  infinitesimal 
in  amount,  toward  protecting  society  from  advanced  cases 
which  are  spreading  contagion. 
16 


450  HENRY     BAIRD     FAVILL 

Already,  even  while  the  warfare  is  so  young,  we  are 
coming  to  see  that  we  have  attacked  the  wrong  end  of  the 
process.  Wherever  careful  observations  have  been  made, 
of  sufficient  breadth  to  be  decisive,  it  is  clear  that  the  only 
great  progress  that  has  been  made  in  limiting  the  disease 
has  been  in  consequence  of  efforts  to  separate  the  dangerous 
or  disease  spreading  cases  from  the  healthy. 

It  is  recognized  that  without  hospitals  or  other  appro- 
priate retreat  for  advanced  cases  of  consumption  the  spread- 
ing of  the  disease  can  not  be  checked.  The  human  problem, 
of  course,  is  far  more  difficult  than  the  animal  problem, 
because  diseased  individuals  must  be  permitted  to  live  out 
their  lives  and  because,  further,  there  is  enormous  prejudice 
against  separating  the  diseased  person,  no  matter  how  dan- 
gerous, from  his  family  and  fellows.  Neither  of  these  con- 
ditions apply  to  cattle.  They  can  be  killed  if  it  is  best  to 
kill  them,  and  they  can  always  be  separated  if  we  will  take 
the  trouble. 

Here,  then,  is  the  key  to  the  situation.  The  cow  which 
is  spreading  tuberculosis  from  her  own  discharges  must  be 
separated  by  death  or  segregation  from  the  others.  I  be- 
lieve this  conclusion  inevitable,  and  that  a  course  of  action 
in  accordance  with  this  principle  will  be  by  far  the  most 
important  factor  in  the  future  of  this  movement.  It  leaves, 
however,  this  most  difficult  question  before  us:  How  can 
it  be  determined  whether  a  cow  is  diseased  and  dangerous 
to  its  community? 

We  have  a  reasonably  satisfactory  method  of  determin- 
ing whether  an  animal  is  diseased  or  not.  We  have  no 
practical  method  of  determining  when  she  has  become  a 
dangerous  point  of  distribution. 

The  conflict  of  opinion  over  the  tuberculin  test  is  very 
intense  and  yet  in  this  clash  of  opinion  there  is  a  distinct 
confusion  of  thought.  The  advocates  of  tuberculin  testing 
maintain  that  a  very  large  percentage,  over  ninety-five, 
of   observations    are    accurate,    that   is   to  say,   a  positive 


A  (;  k  I  (    UF.T  IJ  R  I-:      AND      l>  A  I  K  Y  I  N  (i  451 

reaction  disLinclly  iiic,-uis  Inbcrculosis  of  some  degree  or 
other. 

The  opponents  disputing  this  accuracy  to  a  large  extent, 
also  have  the  strong  argument  that  the  test  in  animals  will 
show  disease  of  distinctly  negligible  amounts.  In  other 
words,  their  contention  is  that  the  tuhercuh'n  test  shows  too 
much. 

Is  it  not  true  that  whether  the  tubereuhn  test  shows  too 
much  or  not,  depends  upon  how  one  treats  the  information 
so  derived?  If  by  precept  or  by  law  we  demand  that  all 
reacting  cattle  shall  be  killed  at  once,  we  are  putting  our- 
selves in  an  untenable  position,  for  three  reasons: 

First,  because  there  is  a  chance  for  error  that  should 
be  corrected  by  subsequent  observation. 

Second,  because  we  would  kill  an  enormous  number  of 
valuable  cattle,  which,  from  an  economic  standpoint,  should 
not  be  killed. 

Third,  because  there  is  a  way  under  proper  circumstances 
of  dealing  with  the  matter  without  this  drastic  process. 

Nevertheless,  while  all  these  considerations  are  sound, 
they  all  must  be  considered  in  the  light  of  the  general 
principle  heretofore  stated,  that  separation  of  disease 
spreading  cattle  from  the  healthy  is  the  only  know^n  safety, 
and  as  a  corollary  thereto,  while  we  are  ignorant  of  any 
means  to  distinguish  dangerous  cattle  from  harmless  cattle, 
all  reacters  should  be  regarded  as  possibly  dangerous  and 
treated  under  the  principles  of  segregation. 

I  am  full}^  aware  that  this  is  generally  regarded  as  im- 
practicable for  the  ordinary  farmer,  but  I  say  it  is  not. 
There  is  no  farmer  whose  ingenuity  and  resources  are  not 
sufficient  to  encompass  this  protection  if  he  believes  in  the 
importance  of  it. 

There  is  one  other  question  of  vital  importance  and  ver^- 
difificult  to  discuss :  How  much  do  living  conditions  of  cattle 
influence  their  susceptibility^  to  disease?  What  has  been 
learned  in  the  way  of  curing  early  tuberculosis  in  human 


452  HENRY     BAIRD     FAVILL 

beings  has  had  an  enormous  reflex  influence  upon  the  Hv- 
ing  conditions  of  the  people.  The  three  elements,  food, 
fresh  air,  and  rest,  that  are  the  foundation  of  cure  in  tu- 
berculosis, are  obviously  the  bulwark  of  protection  against 
tuberculosis.  This  we  have  learned  and  no  one  has  any 
doubt  about  it.  Nevertheless,  even  those  who  have  lived 
in  the  best  of  conditions,  under  certain  kinds  of  exposure 
will  contract  tuberculosis,  so  that  no  one  attempts  to  main- 
tain that  there  is  such  a  thing  as  absolute  immunity.  It 
seems  to  me,  however,  safe  to  assume  that  the  general 
tendency  of  the  race  to  develop  tuberculosis  will  be  limited 
just  in  proportion  to  the  sound  hygienic  life  which  the  race 
may  learn  to  lead. 

If  this  is  true  of  human  beings,  it  is  fair  to  assume  that 
it  is  true  of  cattle.  This  brings  to  the  front,  with  the  ut- 
most emphasis,  the  question  of  living  conditions  of  cattle. 

Time  forbids  that  I  should  discuss  this  matter  in  detail. 
Everyone  knows  how  far  from  perfect  the  best  conditions 
are,  and  how  unutterably  bad  the  worst  conditions  are. 

It  is  for  the  enlightened  and  financially  able  to  deter- 
mine by  every  practicable  means,  and  to  demonstrate  upon 
every  proper  occasion,  the  principles  of  good  hygiene  for 
cattle. 

It  seems  to  me  incumbent  upon  every  breeder  and  every 
extensive  farmer  to  build  his  plans  in  such  a  way  as  to 
throw  light  upon  this  practical  warfare,  and  create  under 
careful  management  object  lessons  for  the  benefit  of  all 
owners.  How  is  the  model  breeder  going  to  keep  and 
influence  his  neighbors? 

The  key  to  the  situation  is  this,  that  the  owner  of  cattle 
shall  want  to  know  whether  his  herd  contains  tuberculosis 
or  not.  Once  he  wants  to  know  he  can  find  out  with  reason- 
able certainty.  Once  he  knows,  his  course  need  encompass 
but  three  things: 

1 .  Actual  and  effective  separation  of  his  diseased  cattle. 

2.  Protection  of  his  calves. 


A  ( i  K  I  (•  n  I>  T  U  RE     AN  h      F)  A  F  U  Y  I  N  C  453 

3.     (lood  livinj^f  coiKlilioiis  for  his  licalthy  cows. 

Need  I  stop  to  acknowledge  at  this  point  all  of  the  weak 
places  in  this  reasoning  based  upon  the  tuberculin  test? 
Let  us  admit  all  of  the  contradictions  and  errors  which  there 
are  in  that  test  under  our  jjrcsent  knowledge,  and  then  be 
profoundly  thankful  that  it  is  as  good  as  it  is.  Without 
it  we  should  be  in  the  densest  ignorance,  but  with  it  we  shall 
work  out  practical  methods  going  very  far  toward  the  solu- 
tion of  our  problem.  It  is  enough  that  at  present  we  have 
a  great  deal  to  learn  al)out  it. 

And  now  let  me  say,  with  full  knowledge  of  how  easy  it 
is  to  say  and  what  difficulties  it  involves,  that  the  essence 
of  this  whole  question  is  education. 

No  more  important  question  faces  the  economic  world 
to-day  than  the  determination  of  comprehensive  and  effec- 
tive schemes  of  education  upon  this  subject.  It  is  quite 
out  of  the  question  to  go  into  that  matter  in  any  consider- 
able detail.  Agricultural  colleges  are  addressing  them- 
selves to  this  subject  assiduously  and  with  great  effect. 
Associations  of  breeders,  I  believe,  can  add  enormously  to 
educative  influence  by  independent  or  cooperative  schemes 
of  education.  Traveling  exhibits,  institutes  of  instruction 
and  comprehensive  field  work,  offer  untold  opportunity 
for  the  dissemination  of  knowledge  and  the  creation  of 
public  opinion. 

I  am  inclined  to  believe  that  wise  legislation  can  be  made 
the  most  eft'ective  educational  influence  open  to  us.  The 
reservations  which  I  have  expressed  with  regard  to  exist- 
ing legislation  are  not  reservations  as  to  its  propriety.  It 
is  as  to  its  effectiveness  as  bearing  upon  the  question  of 
ultimate  eradication  that  I  express  m^^  doubts.  Legislation 
w^hich  is  of  a  summary  and  mandator}'  character,  although 
probably  necessary  to  some  degree,  is  after  all  open  to  these 
objections : 

First,  it  is  never  exacted  upon  ideal  lines.  The  con- 
troversy   arising  over   this  agitation   inevitably  results  in 


454  HENRY     BAIRD     FAVILL 

compromise,  that  almost  invariabty  permits  weak  spots, 
more  or  less  invalidating  the  entire  purpose.  Moreover,  it 
is  acknowledged  that  almost  all  statutes  upon  this  subject 
are  productive  of  more  or  less  injustice.  The  statute  that 
compels  the  cleaning  up  of  a  herd,  and  puts  no  restriction 
in  the  way  of  filling  it  up  with  diseased  cattle,  accomplishes 
nothing.  The  statute  that  fixes  a  compensation  with  a  low 
maximum  value  puts  a  premium  upon  the  condemnation 
and  slaughter  of  inferior  cows  and  of  young  individuals. 
Such  cattle  can  be  condemned  at  a  profit.  It  is  quite  pos- 
sible for  the  State  to  pay  more  than  the  value  of  cattle 
even  if  the}^  were  entirely  sound,  in  the  process  of  con- 
demnation as  tubercular.  These  things  are  matters  of 
practical   adjustment,    which   probably   can   be  solved. 

There  is  a  second  reason  why  mandatory  legislation  is 
ineffective.  It  arouses  widespread  antagonism  on  the  part 
of  farmers  because  of  real  or  fancied  injustice.  It  is  true 
that  the  commotion  created  by  the  passage  of  laws  has  a 
certain  educative  value,  but,  for  the  most  part,  adherence 
to  the  law  is  grudgingly  and  timidly  given,  and  the  grand 
body  of  public  sentiment  amongst  cattle  owners  is  far  from 
cordial  in  its  support. 

The  desideratum  in  legislation  is  the  establishment  of 
standards  to  which  the  owners  of  herds  will  aspire  to  attain. 
This  sounds  like  reaching  out  to  the  millenium.  I  firmly 
believe,  however,  that  there  is  a  practical  possibility  in 
this  direction.  The  psychologic  value  of  cooperation  in- 
vited, as  contrasted  with  obedience  enforced,  is  of  enormous 
importance.  It  would  be  possible  for  the  State  to  establish 
machinery  for  the  purpose  of  accrediting  herds  of  cattle, 
which  would  go  far  in  securing  general  cooperation.  If  the 
owner  of  a  herd  of  cattle  could  be  granted  at  intervals  a 
certificate  setting  forth  that  he  had  complied  with  certain 
specifications  under  conditions  both  intelligent  and  honest 
that  justified  the  warranty  that  his  herd  was,  so  far  as 
possible  at  a  given  moment,   free  from  tuberculosis,   the 


A  (i  R  1  (•  U  F.T  (J  R  I<:     AND     DAIRYING  455 

c.'ij^^crness  of  owners  to  ^et  ujjon  that  accredited  list,  thouj(h 
of  slow  growth,  would  he  irresistible.  This  seems  like  a 
too  simple,  too  feeble  procedure  to  command  much  respect. 
The  very  freedom  from  compulsion  is  its  greatest  strength. 
It  would  undertake  to  place  a  premium  upon  good  con- 
ditions, which  would  have  a  large  pecuniary  value  and  an 
educative  value  in  direct  proportion  to  the  extensiveness 
of  its  operation. 

Voluntary  organization  for  this  purpose,  it  seems  to 
me,  would  not  answer.  The  unquestionable  authority  and 
guarantee  of  the  government  would  be  necessary  for  the 
maintenance  of  confidence  in  the  institution.  What  re- 
lation this  would  bear  to  mandatory  legislation,  it  is  not 
possible  to  foresee.  Clearly  it  could  not  supplant  at  the 
moment  such  legislation,  but  it  has  a  different  purpose, 
a  purpose,  on  the  one  hand  educative  for  farmers,  and  on 
the  other  offering  protective  guidance  to  the  public. 

I  am.  conscious  that  to  throw  out  a  fragmentary  sugges- 
tion like  this  is  not  only  to  invite  criticism,  but  to  raise 
grave  doubts  as  to  the  practicability  of  the  suggestion. 
This  is  no  time  to  discuss  the  matter  in  detail.  In  fact,  I 
have  but  time  to  conclude  my  remarks  by  again  reiterating 
what  I  regard  as  the  three  essential  principles  in  tubercu- 
losis warfare: 

1.  That  it  shall  be  treated  as  a  question  of  the  cattle 
industr>^  and  not  as  a  human  tuberculosis  proposition. 

2.  That  the  only  possible  way  to  limit  the  disease  is 
by  separating  tubercular  cattle  from  non-tubercular  cattle 
and  rearing  healthy  calves. 

3.  That  the  general  resistance  of  cattle  to  tuberculosis 
shall  be  fostered  and  in  a  measure  secured  by  thorough 
sanitary"  living  conditions. 

In  putting  sanitation  last  I  do  not  underrate  it.  But 
I  do  maintain,  that  without  separation  of  diseased  indi- 
viduals and  protection  of  calves,  the  most  perfect  sanitation 
will  fail. 


4S6  HENRY     BAIRD     FAVILL 

In  conclusion,  expressing  my  appreciation  of  having 
been  permitted  to  address  this  gathering,  I  have  to  apol- 
ogize, for  what  seems  to  me  considerable  dogmatic  state- 
ment. 

Let  me,  however,  urge  you  to  bear  in  mind  that  experi- 
ence and  struggle  and  failure  breed  dogmatism  at  times, 
and  that  the  observation  of  physicians  in  this  territory,  of 
tuberculosis  and  health  legislation,  are  not  without  point. 


A(;  R  I  (•  IJ  l>  r  IJ  R  10     AND      DAIRYING  457 


DeliviTC'd    ;i,t,    I  l(jl.slt;in-I''rcisian    Ass(;ciuLi(jii    uf.    America    Convention, 

National  Dairy  Show,  Chicago,  October  30,  1912. 
Printed,   Ilolslrin-Freisian  Register,  December  i,   1912. 

THE   HEALTH   AND    DEVELOPMENT   OF 
THE    DAH^Y   COW 

THERE  is  a  popiiK'ir  impression  that  the  science  of 
agriculture,  the  rapid  progress  of  which  is  a  matter 
of  comment  the  world  over,  is  approaching  the  point 
of  exactness.  This  takes  form  in  a  number  of  generaHza- 
tions  as  to  soil,  seed,  culture,  breeding,  and  rearing  which 
convey  an  exaggerated  impression,  not  only  as  to  actual 
achievements  of  science,  but  as  to  the  relation  it  bears  to 
the  mass  of  knowledge  which  exists  upon  these  subjects. 
So  far  as  relates  to  the  practical  problems  of  the  world, 
scientific  determination  has  usually  followed  practical 
knowledge  and  served  to  organize  it  rather  than  to  initiate 
it.  Almost  everything  we  know  about  the  best  in  agri- 
culture has  been  known  to  somebody  or  to  some  peoples 
for  a  very  great  time,  and  the  significance  of  present-day 
activity,  interest,  and  comprehension  is  not  so  much  the 
discoveries  of  science  as  it  is  the  concentrated  systematic 
promulgation  of  scientific  determination  through  broader 
education. 

The  conclusion,  therefore,  is  necessary  that  accumu- 
lated experience,  from  whatever  sources,  is  of  the  highest 
value  in  the  department  of  agriculture  as  in  other  depart- 
ments of  life,  and  the  problem  before  the  modern  farmer 
is  to  harmonize  that  experience  with  the  facts  which  science 
from  time  to  time  clearly  demonstrates. 

Hence  science  serves  to  illuminate  a  field  thoroughly 
familiar  but  in  many  respects  obscure. 

The  essence  of  science  is  its  spirit  rather  than  its 
statement.  He  who  is  to  be  guided  by  science  must  at 
the  outset  hold  his  knowledge  lightlv,  remaining  eager  for 


458  HENRY     B  A  I  R  D     F  A  V  I  L  L 

information  from  every  source  and  willing  to  take  up  or 
abandon  any  theor}^  as  its  soundness  is  proved  or  dis- 
proved b}^  scientific  progress. 

In  the  field  of  animal  culture,  which  must  always  be 
a  domain  of  agriculture,  there  is  probably  less  actual  ad- 
vance due  purely  to  scientific  discovery  than  in  any  other 
field.  Nevertheless,  suggestions  as  to  methods  and  principles 
in  animal  culture,  which  follow  developments  of  physi- 
ology on  the  one  hand  and  heredity  on  the  other,  are  in 
the  highest  degree  inspiring  and  offer  great  hope  of  signal 
advance  in  the  future. 

It  is  worth  taking  note  of,  that  the  great  discoveries 
in  heredity  have  been  made  in  connection  with  plant  cul- 
ture, and  that  the  discoveries  of  physiology  and  in  part  of 
heredity  have  been  made  in  connection  with  the  lowest  and 
simplest  forms  of  animal  life.  From  this  we  must  derive 
the  lesson  that  inference  and  conclusion  as  to  the  funda- 
mental principles  of  heredity  and  development  are  not 
safely  to  be  founded  upon  observations,  no  matter  how 
intelligent,  made  upon  highly  organized  animals. 

What  we  know  practically  about  breeding,  however, 
and  the  methods  which  we  pursue,  is  as  yet  of  necessity 
founded  upon  the  experience  of  intelligent  and  industrious 
breeders,  and  up  to  this  time  these  demonstrations  must 
be  our  guide. 

There  come  in,  however,  from  time  to  time,  ideas 
founded  upon  studies  in  heredity  upon  the  simplest  forms 
of  life  which  may  be  set  down  as  fixed  principles,  and  it 
is  of  the  utmost  importance  to  the  breeding  enterprise 
that  as  rapidly  as  these  principles  become  established, 
breeders  should  fit  them  in  to  their  scheme  of  ideas  no 
matter  what  apparent  practical  view  may  have  to  be  dis- 
carded in  so  doing. 

The  principles  of  heredity  and  growth  necessarily  can 
be  established  only  in  connection  with  organisms  so  simple 
that  the  terms  of  the  problem  can  be  clearly  seen.     When 


A  ( ;  R  I  C  U  L  T  IJ  R  K      AND     I)  A  I  K  V  I  N  (i  459 

we  come  to  organisms  so  cx)mi)lc;x  as  a  domestic  animal, 
conditions  arc  so  confused  that  it  is  impossible  to  work 
out  scientifically  conclusive  results.  Nevertheless,  con- 
clusions reached  by  scientific  method  can  be  applied  in 
some  degree  to  problems  most  intricate. 

My  theme  to-day  has  to  do  with  heredity,  except  in 
the  broad  generalization  that  it  is  the  fundamental  deter- 
mining influence  in  all  breeding  operations.  The  problem 
of  the  breeder  is  intelligent  selection  on  the  one  hand 
and  painstaking  culture  of  the  products  of  his  selection 
upon  the  other.  My  theme,  therefore,  is  limited  to  pains- 
taking culture  of  animals  which  we  shall  have  bred,  and 
it  is  further  specified  by  my  subject  that  I  discuss  Health 
and  Development. 

The  development  of  a  dairy  cow  is  our  object.  The  ends 
to  be  secured  are  three  —  constitution,  size,  and  specific 
function.  Constitution  is  an  indefinite  word,  of  which  we 
vaguely  conceive  several  desirable  attributes.  Most  im- 
portant of  these  are  capacity  to  assimilate  food,  ability  to 
transform  such  food  into  milk,  to  procreate,  and  to  resist 
disease.  It  is  conceivable  that  we  may  have  either  of 
these  three  without  the  others.  Our  problem  is  to  com- 
bine them. 

It  will  be  seen  at  once  that  the  question  of  size  is  more 
or  less  closely  related  to  the  capacit}^  for  assimilation  of 
food,  also  that  milk  and  reproduction  are  the  essence  of 
specific  function.  The  interesting  question  is.  Are  there 
conflicts  in  the  various  methods  which  we  may  pursue  to 
these  ends?  Aside  from  hereditary  endowment  it  seems 
to  me  clear,  that  the  determining  fact  as  to  the  capacity 
of  a  calf  to  assimilate  food  is  its  daily  habit  and  experience. 
If  we  are  looking  for  the  highest  degree  of  transforming 
power  of  food  into  milk,  it  is  fair  to  assume  that  consist- 
ent pushing  of  the  assimilating  power  within  the  limits  of 
health  maintained  is  necessar}^  to  establish  the  best  results. 
Although  there  is  room  for  the  best  iudgment  as  to  what 


46o  HENRY     BAIRD     FA  V  ILL 

is  consistent  with  health,  all  experience  in  the  rearing  of 
animals,  as  well  as  human  beings,  goes  to  show  that  growth 
and  assiniilative  power  are  both  dependent  upon  judicious 
crowding  of  food  in  the  early  period  of  life.  Let  us  not  be 
led  astray  by  the  popular  dictum  founded  upon  sound 
observation  that  it  is  well  to  keep  calves  hungry.  What- 
ever truth  there  is  in  that  observation,  it  is  but  a  practical 
method  and  not  a  principle.  It  is  simply  a  way  of  satisfy- 
ing ourselves  that  the  calf  is  not  overfed,  and  does  not  at 
all  mean  that  the  purpose  for  which  we  are  working  would 
not  have  been  better  secured  if  the  hungry  calf  had  been 
fed  more.  It  must  consequently  be  regarded  as  a  measure 
of  safety  and  not  as  a  principle  of  action. 

With  other  domestic  animals  whose  rearing  is  attempted 
under  different  physical  conditions,  there  is  no  suggestion 
that  it  is  desirable  to  keep  them  hungry.  In  draft  colts, 
for  example,  whose  value  is  related  to  size,  all  experience 
goes  to  show  that  early  feeding  is  indispensable.  Less 
trouble  occurs  with  them,  however,  because  of  the  freedom 
of  their  lives  as  compared  with  the  hot-house  methods 
employed  with  dairy  calves. 

This  question,  however,  presents  itself  and  is  prominent 
in  the  minds  of  many  breeders:  Does  the  heavy  feeding 
and  development  of  dairy  calves  have  a  tendency  to  trans- 
form them  from  the  dairy  type  to  the  beef  type?  You  are 
perfectly  familiar  with  the  discussion  of  that  subject  and 
with  the  difference  of  opinion  that  exists.  Practical  men 
have  had  actual  experience  that  leads  them  to  fear  such 
conflict. 

My  opinion  is  that  no  such  conflict  need  occur.  I  believe 
that  where  full  feeding  of  dairy  stock  has  had  bad  results, 
if  at  all,  it  is  in  incorrect  feeding  rather  than  excessive  feed- 
ing. Let  me  here  call  attention  to  the  fact  that  growth  of 
a  calf  is  a  matter  of  skeleton  and  not  a  matter  of  flesh.  All 
people  agree  that  the  dairy  cow,  and  particularly  the  Hol- 
stein-Friesian  cow,  should  be  brought  to  its  full  size.     All 


A  (;  K  [  (    IJ  I.  T  U  R  K      AND     I)  A  I  R  Y  [  N  (i  46/ 

breeders  kn()w  Ihril  it  is  only  to  be  brouj^ht  to  its  full  size 
l)y  forcin;^^  il  diiriiij.^  its  first  two  years.  The  simple;  r)iiestion 
is,  need  anyone  fear  to  do  it  lest  he  im[)air  the  inilk  function  ? 

So  far  I  have  an  opinion  based  upon  knowledge  of  i>hysi- 
ology.  I  am  strongly  of  the  opinion  that  the  heaviest  feed- 
ing, consistent  with  health,  of  proper  skeleton-forming  foods 
can  not  interfere  with  the  dairy  type.  I  believe  that  the 
dairy  function  is  not  an  accident;  that  it  is  an  endowment 
derived  from  the  sum  of  the  ancestors,  and  that  whatever 
possibilities  there  are  in  a  given  animal  are  to  be  fostered 
and  augmented  by  strong  feeding  in  youth,  rather  than  the 
reverse. 

So  far  as  science  throws  any  light  upon  it  at  all,  it  dis- 
tinctly favors  that  view  of  the  matter.  My  conclusion, 
therefore,  is  that  in  our  effort  to  create  a  strong  transforming 
machine  for  turning  food  into  milk  we  not  only  must  begin 
this  early,  but  we  need  not  fear  that  in  the  process  we  shall 
destroy  the  milk  type  by  creating  another  type.  If  there 
is  no  such  fear,  then  the  factor  of  size  is  at  the  same  time 
secure,  and  if,  moreover,  it  is  true  that  assimilative  power, 
skeleton,  and  milk  function,  are  all  dependent  upon  essen- 
tially the  same  kind  of  food,  namely,  high  protein  food, 
the  problem  seems  to  take  a  definite  form. 

Right  here  let  me  call  your  attention  to  something  which 
is  not  always  realized.  Bones  are  not  primarily  lime  or 
phosphate.  They  are  primarily  tissue,  more  like  gristle,  a 
high  protein  substance,  and  must  have  abundance  of  proteid 
material  to  form  them.  Lime  and  other  salts  are  put  into 
them  ultimately  for  the  purpose  of  stiffening,  but  growth 
of  the  skeleton  is  a  proteid  grow^th.  This  w^e  are  liable  to 
forget. 

There  remains,  however,  a  further  phase  to  constitution, 
of  the  utmost  importance  —  resistance  to  disease.  Let  us 
depart  from  the  narrow  question  of  cows  to  the  general 
question  of  relationship  of  animals  to  disease.  Most  of  the 
diseases   in   question   are   infectious   diseases.     In   general. 


462  HENRY     BAIRD     FA  V  ILL 

they  must  be  regarded  as  a  struggle  in  the  bod}'  of  an  animal 
to  prevent  the  undue  development  of  lower  forms  of  life, 
usually  low  plant  life,  under  the  general  term  of  "germs." 
Every  sickness  represents,  not  what  the  germ  is  doing  to  the 
animal,  but  the  struggle  which  the  animal  is  making  against 
the  germ.  If  it  succeeds,  it  survives;  if  it  does  not  succeed, 
it  perishes.  But  sickness  is  a  manifestation  of  warfare  and 
not  a  mere  passive  surrender.  Fever,  for  example,  is  proba- 
bly a  conservative  process  and  not  destructive.  It  is  Na- 
ture's method  of  meeting  the  germ  attack  by  what  we  re- 
gard as  resistance.  In  the  body  of  every  animal  struggling 
with  infectious  disease  there  are  forming  antagonistic  chemi- 
cal substances  whose  purpose  is  protection.  All  serums 
which  we  use  in  practice  are  the  products  of  such  protec- 
tive reaction  and  in  so  far  as  they  are  useful  it  is  because  of 
some  specific  power  they  have  to  increase  the  defense  of  the 
animal  against  the  invader. 

If  it  is  true  that  all  animals  have  a  certain  degree  of 
power  to  protect  themselves  against  disease  germs,  the  ques- 
tion of  hygiene  becomes,  how  to  favor  the  development  of 
resistance.  Let  me  call  your  attention,  for  example,  to  the 
modern  theory  and  method  of  treating  human  tuberculosis. 
Fresh  air,  food,  and  rest  are  cardinal  principles. 

Do  not  get  the  idea  that  fresh  air  is  valuable  because  it 
does  not  contain  tuberculosis  germs.  It  may  or  may  not 
contain  germs,  but  its  value  undoubtedly  is  in  its  tonic 
effect  upon  the  entire  cellular  mass  of  which  the  animal  is 
made  up.  So  also  as  to  food.  There  is  no  antagonism 
between  milk  and  eggs  and  tuberculosis  germs.  The  bene- 
fit lies  in  the  fortification  of  the  tissues  in  the  minutest 
particle  for  carrying  on  its  own  protective  resistance.  So, 
also,  as  to  rest.  Probably  rest  in  tuberculosis  is  of  value 
because  it  permits  the  assimilative  power  of  the  organism 
to  be  concentrated  on  the  upbuilding  of  the  cells  and  does 
not  dissipate  their  powers  in  unnecessary  activities. 

In  fact,   it  is  now  manifest  that,  in  combating  tuber- 


AGRICULTURE     AND     F)  A  I  R  Y  I  N  (,  463 

culosis  in  hinii.'in  hdnj^s  which  is  already  established,  there 
is  a  value  in  j^rcscrihinji;  activity  whic-h  shall  result  in  a  reac- 
tive fever  representing  the  natural  defense  of  the  body, 
following  which  activity,  perfect  rest  permits  the  utilization 
of  the  ])rotcctive  products  in  killing  out  the  tuberculosis 
germ.  The  whole  thing,  however,  presents  itself  as  a  picture 
of  the  warfare  between  a  body  and  its  enemy.  If  this  is 
true  as  to  disease  already  established,  is  there  not  a  truth 
necessary  for  us  to  accept  as  to  the  fortification  of  a  body 
not  yet  diseased? 

In  the  city  of  Chicago,  as  in  other  places,  we  have  had 
valuable  light  upon  this  subject.  Young  children  of  a  school 
age  who  have  tuberculosis  have  been  taken  out  of  the  school 
room,  properly  clothed,  and  put  upon  the  roof  of  buildings 
somewhat  protected  against  the  wind,  properly  fed  and  prop- 
erly rested,  but  still  continuing  school  work,  and  have  been 
transformed  from  puny,  deteriorating,  mentally  defective 
children,  into  growing,  strong,  and  mentally  alert  children. 
This  experiment  has  now  gone  so  far  as  to  make  it  beyond 
question  that  the  proper  way  to  handle  such  children  is  in 
the  open  air,  under  proper  conditions,  no  matter  how  cold 
or  inclement  the  weather. 

The  time  was  when  most  of  the  animals  in  the  zoologi- 
cal garden  of  Lincoln  Park  were  prone  to  tuberculosis.  Since 
changing  the  method,  making  them  live  out  of  doors,  the 
entire  picture  has  changed,  and  they  now  live  and  maintain 
a  degree  of  health  hitherto  unknown.  This  applies  not  onh" 
to  monkeys  and  smaller  animals  but  even  to  lions.  Out 
of  this  we  have  gleaned  a  lesson  and  have  reached  the 
conclusion  that  good  hygienic  conditions  should  not  be 
confined  to  those  who  are  already  diseased. 

To-day  in  Chicago  the  movement  is  on  foot  to  put  all 
children  who  are,  as  we  say,  sub-normal,  into  open-air 
schools.  The  result  of  these  efforts  is  astonishing.  Not 
only  do  these  children  thrive,  gain  in  weight,  and  grow, 
but,  they  become  mentally  normal,  when  almost  invariably 


464  HENRY     BAIRD     FA  V  ILL 

they  have  hitherto  been  mentally  backward.  They  accom- 
plish in  the  school  curriculum  from  30  to  100  per  cent  more 
in  the  year  than  the}^  did  under  the  former  conditions,  and 
in  every  way  the  experiment  shows  that  the  element  which, 
for  want  of  a  better  name,  we  call  vitality,  was  lacking  and 
that  that  vitality  can,  in  the  majority  of  instances,  be  sup- 
plied by  food  and  fresh  air,  and  I  think  it  is  true  that  neither 
will  accomplish  this  result  without  the  other. 

Can  there  be  any  doubt  as  to  the  importance  of  the 
bearing  of  this  experience  upon  our  dairy  problem?  Ad- 
mitting, as  we  must,  the  menace,  to  our  industry,  of  tuber- 
culosis, to  say  nothing  of  other  infectious  diseases,  halting 
along  unsatisfactorily  as  we  do  with  the  tuberculin  test  and 
its  weeding-out  method,  can  we  close  our  eyes  to  the  fact 
that  safety  in  this  situation  lies  in  the  development  of  a 
vital  resistance  and  that  particularly  in  the  earliest  months 
of  life? 

At  this  point  I  want  to  call  attention  to  this  fact.  Resist- 
ance to  infectious  disease,  aside  from  tuberculosis,  is  by  no 
means,  so  far  as  we  know,  related  to  size,  vitality,  or  consti- 
tution. There  are  many  infectious  diseases  amongst  human 
beings,  which  apparently  attack  the  very  strong  as  danger- 
ously and  perhaps  more  dangerously  than  the  apparently 
weak.  We  are,  however,  at  sea  as  to  what  we  mean  by 
very  strong  and  consequently  are  not  yet  ready  to  interpret 
this  observation;  but  so  far  as  concerns  tuberculosis,  it  is 
beyond  question  that  the  strong,  well  developed  animal 
with  large  lung  power  habitually  used  is  more  resistant  to 
tuberculosis  than  the  feeble  and  delicate. 

We  must,  however,  bear  in  mind  that  there  is  no  such 
thing  as  absolute  immunity,  and  that  any  animal  that  is 
too  constantly  subjected  to  infection  is  liable  to  become 
tuberculous. 

There  is  no  question  that  there  is  less  infectious  material 
outside  the  barn  than  within  it.  When  we  stop  to  consider, 
therefore,  the  highly  stimulated  resistance  on  the  one  hand, 


A  (;  K  J  C  IJ  F.  T  U  RE     AN  I)      F)  A  F  l<  V  F  \  (,  465 

and  the  loss  cxijosiirc  to  infection  t,h,'il  there  is  in  the  open 
air  on  tlie  oilier,  can  we  avoid  the  conclusion  that  our  ani- 
mals, and  parlieularly  our  youn^'  animals,  arc  safer  in  the 
open  air  than  they  are  in  the  harn? 

If  we  ado])t  that  as  a  fnndaiiicntal  jH-ineiijle,  there  re- 
mains for  us  tlie  prol)leni  of  fitlin^^  this  i>rincij)]e  into  our 
scheme  of  operation. 

There  is  no  doubt,  for  example,  that  calves  can  be  kept 
looking  better  in  the  stable  than  in  the  open  during  certain 
seasons  of  the  year.  There  is  no  doubt  that  the  attack  of 
flies  upon  young  stock  hampers  its  development.  There 
is  no  doubt  that  exposure  to  cold  roughens  their  general 
condition  and  appearance.  It  takes  more  food  to  keep  them 
in  condition  in  open  air  than  in  stable  life. 

Have  we  not  to  accept  these  immediately  obvious  dis- 
advantages and  regard  them  as  far  more  than  offset  by  the 
advantage  not  so  immediate  nor  so  obvious,  but  none  the 
less  possible,  as  to  development,  constitution,  and  resistance 
to  disease,  which  our  intelligence  teaches  us  really  pertains? 
As  farmers  we  are  altogether  too  prone  to  follow  the  line 
of  least  resistance,  and  the  line  of  least  resistance  is  the  old 
plan  of  a  six  to  twelve  months'  sentence  to  more  or  less 
solitary  confinement.  Have  we  not  to  use  our  ingenuity  and 
our  liberality  in  dealing  with  this  problem  before  we  can 
have  reasonable  assurance  of  the  vitality  of  our  stock  to  come  ? 

It  has  been  suggested  that  continued  breeding  from 
tuberculosis  cattle,  avoiding  infection  of  the  calves,  would 
produce  a  race  of  animals  immune  from  tuberculosis.  The 
theory,  though  attractive,  is  not  thus  far  substantiated,  and 
I  have  no  opinion  to  express  as  to  its  possibility.  It  cer- 
tainly, however,  is  as  likely  to  be  true  as  the  reverse,  name- 
ly the  production  of  more  susceptible  animals.  There  is  no 
reason,  therefore,  so  far  as  we  now  know,  "why  we  should 
not  judiciously  breed  from  tuberculous  cattle. 

One  aspect  of  the  matter  of  development  I  wish  to  call 
attention  to  in  passing.     We  assume  that  growth  is  directly 


466  HENRY     BAIRD     FA  V  ILL 

related  to  and  dependent  upon  abundance  of  food.  In 
general  this  is  true,  nevertheless  we  must  understand  that 
the  process  of  growth  is  presided  over  by  certain  definite 
organs  in  the  body  not  well  understood,  the  function  and 
activity  of  which  we  know  generally  through  abnormality. 
There  are  glands  known  as  the  thyroid  gland,  thymus  gland, 
pituitary  gland,  and  suprarenal .  gland,  and  others  whose 
delicate  balance  of  activities  in  the  body  apparently  deter- 
mine normal  growth. 

When  this  balance  is  disturbed  in  certain  diseased  con- 
ditions of  some  of  these  glands,  we  find  abnormal  develop- 
ment. All  giants,  for  example,  are  not  simple  overgrowth 
but  are  evidences  of  unrestrained  activity  of  certain  of  these 
internal  glands.  We  know  very  little  about  this  but  we  do 
know  that  the  forces  making  for  development  are  intricately 
inter-balanced  amongst  these  important  organs.  There  is  no 
definite  assistance  to  be  gained  from  this  knowledge  except 
this :  it  is  a  fair  assumption  that  balance  is  to  be  maintained 
amongst  these  obscure  but  influential  functions  by  maintain- 
ing the  best  of  health  and  under  the  most  favorable  condi- 
tions. The  more  we  know  of  these  matters  the  more  we  are 
driven  to  the  conclusion  that  nature  is  to  be  followed  and. 
assisted.  In  spite  of  the  fact  that  in  the  case  of  the  modern 
highly  developed  dairy  cow  we  are  dealing  with  a  most 
unnatural  product,  there  is  no  reason  to  suppose  that  the 
factors  determining  life  and  constitution  have  not  a  true 
and  fundamental  relation  to  natural  conditions  of  exist- 
ence. The  question,  then,  always  is,  to  what  extent  the 
unnatural  development  of  the  milk  function  and  the  industry- 
built  upon  it  necessitates  unnatural  conditions  of  living  for 
the  animals.  And  the  principle  should  be  to  draw  the  line 
as  close  to  natural  conditions  as  the  industry  will  permit. 
In  so  doing  there  is  opportunity  for  exercising  the  best 
judgment,  but  I  wish  to  say  that  the  tendency  of  dairying 
is  to  draw  the  line  at  convenience  rather  than  at  the  point 
of  highest  health  advantage. 


ACRICULTURE     AND      l>  A  I  R  Y  I  N  (i  467 

In  closinj^  I  wish  to  reaffirm  my  appreciation  of  experi- 
ence, but  also  plead  for  an  open-minded  reception  of  scien- 
tific demc^nslration  and  correction  when  it  shall  appear; 
to  warn  aji^ainst  deductions  involving  questions  of  scien- 
tific principle  from  observations  made  upon  organisms  too 
complex  and  under  conditions  not  open  to  control;  and 
finally,  to  urge  breeders  who  are  striving  to  produce  dairy 
cows,  not  so  to  distrust  heredity  as  to  expect  to  be  able  to 
sidetrack  the  dairy  capacity  by  furnishing  abundant  food. 

There  is  no  question  that  great  dairy  possibilities  can  be 
reduced  and  rendered  very  ordinary  by  mismanagement  of 
the  individual,  just  as  there  is  no  question  that  good  man- 
agement can  bring  them  to  their  height,  but  the  features 
involved  in  these  questions  of  management  are  far  more 
specific  and  influential  and  are  none  of  them  measures  which 
divert  type,  but  simply  such  as  tend  to  develop  or  not  to 
develop  the  opportunity. 

The  breeders  of  Holstein  cattle  are  charged  with  a  grave 
responsibility.  At  the  outset  strongly  impressed  with  the 
importance  of  type,  they  have  allowed  themselves  to  be- 
come somewhat  one-sided  in  the  direction  of  performance. 
Granted  that  performance  is  the  ultimate  purpose  of  the 
dairy  cow,  I  think  it  needs  no  argument  to  prove  that,  gen- 
erally speaking,  there  is  a  type  which  carries  with  it  not  only 
the  best  performance  but  the  best  physique. 

It  seems  to  me,  therefore,  that  a  moral  obligation  rests 
upon  the  breeders  of  pure  blood  cattle  to  steadfastly  fight 
for  type,  not  as  a  mere  aesthetic  achievement,  but  as  having 
fundamental  relation  to  performance. 

To  this  end,  it  is  imperative  that  breeders  add  to  their 
discussions  of  performance  the  most  profound  and  pains- 
taking study  of  health  and  development,  in  order  to  avoid 
the  inevitable  deterioration  that  comes  from  one-sided 
estimate  of  value. 


468  HENRY     BAIRD     FA  V  ILL 


Delivered,  Wisconsin  Livestock  Breeders'  Association,  Madison,  Wis., 

February  6,   19 13. 
Printed,  Holstein-Friesian  Register,  August  i,  1913. 

BUYING   AND   SELLING   LIVE   STOCK 

THE  ultimate  purpose  of  a  stock  handler  is  to  sell  his 
stock,  which  has  appreciated  in  value  through  the 
attention  that  he  has  devoted  to  it.  The  essence  of 
this  question  is,  consequently,  appreciation  in  value.  In  order 
to  justify  as  a  business  proposition,  stock  must  be  acquired 
either  by  breeding,  or  by  purchasing  at  an  advantageous 
price.  It  must  be  grown  and  developed  by  judicious  use  of 
materials.  It  must  be  marketed  under  conditions  which 
secure  to  the  owner  a  fair  price.  Under  favorable  conditions 
this  price  will  mean  a  profit.  Under  conditions  only  slightly 
unfavorable,  this  price  will  mean  a  loss.  The  lapse  of  time 
between  the  first  term  of  this  sequence  and  the  last  varies. 
It  may  be  a  short  time  in  the  case  of  swine ;  it  may  be  a 
very  long  time  in  the  case  of  dairy  stock;  but  the  period 
always  is  long  enough  and  the  steps  involved  sufficiently 
obscure  to  make  it  quite  possible  to  be  lacking  a  clear  knowl- 
edge as  to  whether,  on  the  whole,  the  transaction  has  been 
profitable  or  the  reverse. 

It  is  not  my  purpose  here  to  go  into  the  subject  of  farm 
economics.  It  is  with  regard  to  the  first  and  last  term  that 
I  am  asked  to  give  my  views.  The  buying  and  selling  of 
livestock  are  the  extreme  acts  in  this  commercial  transac- 
tion. Generally  speaking,  a  farmer  does  not  buy  a  great  deal 
of  live  stock.  Nevertheless,  it  is  probable  that  a  wise  and 
progressive  farmer,  even  though  an  extensive  breeder,  will 
purchase  more  or  less  stock,  and  of  course  with  respect  to 
breeders  and  feeders  of  cattle  for  the  market,  purchase  will 
be  a  regular  factor. 

The  limits  of  this  paper  will  not  permit  a  broad  discussion 
of  those  activities.     General  principles  are  true  for  all  phases 


A(;  R  I  C  n  [.  T  IJ  RE     AND     DAIRYING  4^>9 

of  the  iii.'Li-kcl,  .'iikI  specific  consiflcrations  are  very  many 
with  respect  to  the  purchase  anrl  sale  of  dairy  cattle,  to  which 
I  shall  direct  my  attention. 

Demand  for  more  economic-al  production  of  dairy  cattle 
and  dairy  imxluce  is  emphatic.  As  farmers  come  to  realize 
the  small  marj^in  upon  which  they  have  been  runninj^, 
representing  the  value  of  product  above  cost  of  production, 
they  become  eager  for  better  stock.  Whatever  specific 
method  they  pursue  to  acquire  such  stock,  the  element  of 
purchase  is  incvital)ly  important. 

To  any  individual  the  question  therefore,  is,  How  can  I 
buy  the  thing  which  I  need  to  reinforce  my  herd  ?  The  ques- 
tion is  not  simple.  His  neighbor  does  not  as  a  rule  offer  for 
sale  his  best  cattle.  The  time  and  effort  involved  in  hunt- 
ing for  stock  are  almost  prohibitive.  The  opportunity  for 
careful  estimate  as  to  the  value  and  adaptability  to  his  par- 
ticular needs  is  meager  and  inadequate.  The  result  is  that 
it  is  more  difficult  to-day  to  purchase  stock  safely  than  it  is 
to  market  it. 

For  the  farmer  who  is  patiently  undertaking  to  build  up 
a  herd,  the  proposition  is  not  so  difficult.  The  careful  pur- 
chase of  a  sire,  coupled  with  intelligent  selection  of  produce, 
is  probably  an  adequate  process. 

For  those,  however,  who  are  anxious  to  branch  out  into 
more  rapid  or  more  aggressive  breeding  operations  there  is 
a  necessity  for  broader  operations.  As  a  result,  there  has 
grown  up  in  the  dairy  w^orld  the  institution  of  public  sales, 
which  will  furnish  a  market  for  those  who  w4sh  to  buy  and 
those  who  wish  to  sell.  On  the  face  of  it  this  appears  to  be 
a  simple  and  eft'ective  process,  whereby  the  needs  of  all  can 
be  accommodated.  Deeper  analysis,  however,  would  teach, 
and  experience  has  clearly  demonstrated,  that  the  public 
sale  is  good  or  bad  according  to  its  character. 

If  it  is  true  that  the  public  sale  is  a  sound  business  idea, 
as  I  believe  it  is  true,  the  problem  is  then  simplified,  even 
if   not   made   easy,   by  concentrating  attention  upon  the 


470  HENRY     B  A  I  R  D     F  A  V  I  L  L 

fundamental  character  of  the  sale.  There  are  breeders  who 
have  sufficient  leisure,  sufficient  capital,  and  a  large  enough 
business  organization,  to  provide  themselves  with  what 
cattle  the}^  need,  at  private  sale.  There  are  breeders  whose 
standing  has  been  sufficiently  established  to  be  able  to  sell 
in  private  a  surplus  which  they  care  to  market ;  but,  taken  by 
and  large,  these  conditions  do  not  obtain  and  the  great  mass 
of  breeders  who  wish  to  carr^^  on  operations,  be  they  more  or 
less  in  extent,  need  a  stable  machinery  for  marketing  upon 
which  they  can  depend  and  toward  which  the  purchasing 
or  selling  public  shall  turn  with  confidence. 

I  call  your  attention  to  the  fact  that,  in  the  long  run, 
the  essence  of  this  proposition  is  confidence,  and  the  founda- 
tion of  confidence  is  experience. 

In  the  hurly-burly  of  stock  trade  in  recent  years,  many 
needs  have  developed  which  furnish  food  for  careful  reflec- 
tion. The  average  farmer,  who  has  a  few  cows  and  heifers 
to  dispose  of  in  the  year,  really  needs  a  broker. 

Thus  far,  public  sales  of  grade  cattle  have  not  been  fre- 
quent. It  will  probably  be  a  long  time  before  grade  cattle 
will  be  so  disposed  of  in  general.  There  is  no  essential 
reason,  however,  why  regular  sales  calculated  to  handle 
the  surplus  of  the  average  farmer  in  groups  and  communi- 
ties can  not  be  developed. 

There  is,  however,  some  question  whether  that  is  an 
economic  project.  Experience  has  not  sufficiently  devel- 
oped to  show  whether  the  great  fluctuations  in  the  demand 
for  grade  cattle  can  be  adequately  foreseen  and  met  by 
sales  at  stated  intervals. 

In  Great  Britain  the  local  sales  and  markets  are  devel- 
oped to  a  high  degree.  Conditions  there  are  very  different, 
both  as  to  farm  economics  and  as  to  distribution  and  extent 
of  territory,  so  that  conclusions  are  not  drawn  lightly  from 
analogy;  but  even  our  present  method  of  buying  and  selling 
milch  cattle  through  buyers  and  brokers  is  finally  dependent 
upon  the  quality  and  integrity  of  the  man  so  employed. 


AGRICULTURE     AND     I)  A  I  R  Y  I  N  G  471 

Investigation  will  show  that  there  is  as  much  or  more 
difference  in  the  standing  of  cattle  brokers,  both  with  farmers 
from  whom  they  buy  and  the  large  consumei  s  to  whom  they 
sell,  than  there  is  in  the  standing  of  sales  organizations 
which  are  dealing  in  purebred  eaille. 

The  sti])ulations  which  wc  nvc  about  to  make  as  to  public 
sales  can  be  made  with  ec|ua1  force  as  to  the  operations  and 
reliability  of  local  buyers.  The  man  who  has  standing  as  a 
square  dealer  deserves  our  support.  The  man  who  has  the 
reputation  of  being  tricky  deserves  no  confidence. 

It  is  open  to  any  farmer  having  stock  for  sale,  with  the 
present  large  demand  for  stock,  to  make  his  choice  as  to  the 
kind  of  buyer  with  whom  he  will  deal.  In  the  long  run  a 
dishonest  buyer,  even  though  he  pay  to  the  farmer  full 
price,  will  damage  the  market.  The  honest  and  trust- 
worthy buyer,  even  though  he  be  a  somewhat  closer  buyer, 
in  the  long  run  will  strengthen  the  market.  It  is  important 
for  farmers  to  realize  this  remote  development  of  what 
seems  at  any  one  moment  to  be  a  minor  consideration. 

With  reference  to  purebred  animals,  market  considera- 
tions are  somewhat  different  and  in  some  ways  much  more 
important. 

Why  should  farmers  go  in  for  purebred  stock?  The 
ordinary  answer,  that  purebred  stock  is  better,  is  not  suffi- 
cient answer. 

In  the  first  place,  purebred  stock  is  not  necessarily  bet- 
ter than  well-bred  grade  stock.  All  observers  know  that 
in  well  managed  herds  containing  both  grade  and  purebred 
stock  the  grade  may  show  fully  as  much  profit  in  immediate 
production. 

Considering  the  cost  of  investment,  this  condition  may 
obtain  up  to  the  point  of  high  development  in  the  purebred 
enterprise.  Outside  of  mere  fancy,  the  only  sufficient 
reason  for  going  into  purebred  dairy  stock  is  a  deliberate 
purpose  to  build  up  consistently,  patiently,  and  through  a 
long  period  of  time,  a  herd  of  really  high  quahty. 


472  HENRY     BAIRD     FA  V  ILL 

The  question  may  be  easily  asked,  Is  that  not  always 
the  reason?  Based  upon  observation,  my  answer  is  in  the 
negative. 

In  a  vague  way,  the  purpose  of  handling  purebred  stock 
would  always  be  stated  as  an  effort  to  build  up  a  fine  herd, 
but  in  point  of  fact  we  know  that  in  the  minds  of  many 
farmers  who  thus  embark  there  is  a  strong  element  of  gam- 
ble. We  have  become  dazzled  by  phenomenal  production 
and  sensational  prices. 

Every  breeder  of  registered  dairy  cattle  must  carry 
somewhere  in  his  mind  the  possibility  of  producing  such 
phenomena.  The  test,  however,  of  soundness  of  the  enter- 
prise is  the  idea  which  dominates  the  matter.  The  breeder 
who  purchases  his  purebred  stock,  breeds  them,  tests  them, 
and  develops  them,  with  reference  to  elevating  the  whole 
standard  and  quality  of  his  herd  and  farm  will  succeed  and 
will  profit  correspondingly  by  being  in  the  purebred  ranks. 
The  breeder  who  buys,  breeds,  and  tests  with  the  sole  pur- 
pose of  making  large  records,  and  of  being  able  to  sell  at 
sensational  prices,  is  more  than  liable  to  fail. 

The  farmer  who  makes  his  agricultural  operations  pri- 
mary, and  handles  his  stock  as  an  essential  but  still  subordin- 
ate part  of  his  operations,  will  progress. 

The  farmer,  who,  carried  away  by  the  glamour  of  excep- 
tional production  and  intoxicating  publicity,  neglects  his 
farm  and  allows  it  to  be  subordinate  to  his  stock  interests, 
will  retrogress. 

The  difference  is  distinctly  one  of  ideals,  and  in  no 
branch  of  human  industry  are  ideals  of  more  importance 
nor  more  calculated  to  make  or  break  an  enterprise.  The 
way  is  strewn  with  the  wrecks  of  breeders  who  have  substi- 
tuted for  their  agricultural  ideals,  purely  speculative  ideals. 

I  feel  that  we  can  not  too  deeply  realize  nor  too  strongly 
warn  against  the  unsoundness  of  such  agricultural  concep- 
tions. It  is,  consequently,  for  the  benefit  of  those  farmers 
who  have  genuine  agricultural  ideals  and  sound  plans  that 


A  (;  RI  (•  n  LT  U  RE     AND     DAIRYING  473 

wc  imisl,   ('ni])lKisizc^   the    iin|jorl  riiicc   of   ;i  reliable  market. 

If  it,  could  ever  be  true  that  the  jjurchaser  of  a  dairy 
animal  eonld  know  by  ins])eetion  all  of  the  facts  necessary 
to  intellij^ent  seleetion,  there  would  be  little  difficulty.  Asa 
matter  of  fact,  however,  tlie  history  of  an  animal,  either  as 
an  individual  or  through  its  ancestry,  is  essential  to  its 
valuation.  The  question,  then,  is  simple,  Shall  the  history 
be  true  or  false,  complete  or  incomplete?  This  is  the  crux 
of  the  whole  .situation. 

In  some  respects,  in  the  purebred  circles,  the  history  of 
animals  has  been  carefully  recorded  and  its  accuracy  safe- 
guarded so  that  there  is  practically  no  risk.  The  pedigree 
is,  as  a  rule,  beyond  question.  The  official  record  as  to  pro- 
duction, so  far  as  the  actual  test  goes,  is  practically  safe- 
guarded. In  both  of  these  respects  what  is  now  lacking  can 
easily  be  reinforced,  but  there  are  other  considerations  in- 
volved of  the  greatest  importance  which  relate  not  to  pub- 
lic records  but  to  the  private  knowledge  of  the  owners. 
Herein  lies  the  factor  of  very  great  difficulty.  To  what 
extent  is  an  owner  under  obHgation  to  state  all  the  facts 
with  reference  to  his  animal?  At  how  much  pains  must  he 
present  a  true  picture  of  it? 

Such  questions  go  into  the  very  depths  of  human  con- 
flicts, and  serve  to  set  before  us  all  conceivable  gradations 
of  honesty. 

It  is  not  Hkely  that  in  this  Hne  of  business  universal 
honesty  can  be  expected  more  than  in  other  business.  The 
question,  then,  becomes,  What  are  the  practical  means 
wliereby  uncertainty  and  chicaner}^  can  be  reduced  to  the 
minimum,  and  in  consequence,  reliability  and  confidence 
brought   to  the  highest   level? 

Up  to  this  time  these  requirements  have  not  been  met 
with  any  considerable  completeness.  Although  I  think  it 
is  fair  to  say  that  the  quaHty  of  the  sales  and  the  standards 
controlling  have  improved  somewhat,  close  observers  of 
the   situation   know   that   there   are   not   established  such 


474  HENRY     BAIRD     FAVILL 

rigid  standards  of  dealing  as  are  indispensable  if  the  public 
sale  is  to  become  a  permanent  and  reliable  factor  in  our 
agricultural  calculations. 

There  has  been  too  much  tendency  for  the  managers  of 
sales  to  say  that  the  public  must  take  its  own  chances, 
assuming  that  they  assert  nothing  that  is  untrue.  As  a 
gambling  proposition,  that  is  undoubtedly  reasonable,  but  as 
applying  to  the  serious  question  of  developing  a  phase  of  our 
public  welfare  problems,  it  is  indefensible. 

There  are  two  essential  elements  in  the  makeup  of  a 
public  sale.  One  is  the  quality  of  the  stock  offered;  the 
other  is  the  ideals  dominating  the  sale  and  all  that  pertains 
to  it.  As  between  a  sale  of  poor  stock  with  good  ideals 
and  a  sale  of  good  stock  with  poor  ideals,  the  sale  with  poor 
ideals  will  do  infinitely  more  harm. 

There  is  a  natural  pride  which  sales  managers  entertain 
as  to  the  results  of  a  sale  measured  in  money  or  average 
price.  It  is  perfectly  right  that  a  management  should  desire 
to  present  for  approval  stock  which  the  public  will  accept 
at  a  high  valuation,  but  cunningly  to  devise  methods  where- 
by the  average  sale  price  shall  be  artificially  exaggerated, 
with  all  its  attendant  injustice,  is  worthy  only  of  condem- 
nation. Not  only  is  it  hard  upon  the  purchasing  public, 
but  it  absolutely  blows  out  the  foundations  from  the  in- 
stitution which  we  are  trying  to  erect. 

I  repeat,  the  foundation  of  the  public  sale  in  the  long  run 
must  be  confidence,  and  confidence  can  be  built  up  only 
by  unwavering  allegiance  to  honest  methods. 

In  this  indictment  I  have  not  in  mind  specific  sales.  I 
have  in  mind  in  some  degree  or  other  the  whole  sale  business 
as  it  has  been  up  to  this  time  conducted.  There  are  de- 
grees of  departure  from  that  which  ought  to  be.  Some 
sales  are  worse  than  others,  but  it  does  not  lie  in  the  mouth 
of  anybody  engaged  in  public  sales  to  make  charges  against 
others  unless  he  can  come  into  the  field  with  absolutely 
clean  hands. 


A  (;  R  1  (•  U  L  T  U  R  E     AND     DAIRYING  475 

It  is  not,  i)i-('smnal)l('  llinl,  .'i,  breeder  is  likely  to  oficr  at 
public  sale  any  considerable  percentage  of  his  best  cattle; 
but  it  clearly  lies  within  the  province  of  the  sale  manaj^e- 
ment  that  he  shall  not  offer  his  worst  cattle.  It  seems  to 
me  that  not  only  llu^  ])til)]ic  interest  bill,  principles  of  self 
])rcscrvation  should  make  it  imjoerativc  for  the  sale  man- 
agement to  exercise  such  supervisif>n  and  selection  of  offer- 
ings as  shall  be  consistent  with  its  standards  and  prop- 
ositions. It  is  also  entirely  within  the  province  of  a  sale 
management  to  discriminate  against  consignors  who  are 
known  to  be  untrustworthy.  The  public  sale  is  not  a 
matter  of  sentiment.  It  is  a  matter  of  business,  a  matter 
of  good  faith,  and  a  matter  of  public  service. 

These  factors  are  not  antagonistic ;  they  are  entirely  con- 
sistent, and  in  fact,  a  sale  which  does  not  give  due  weight 
to  all  these  will  never  become  a  trustworthy  institution. 
I  will  go  further  and  say  that,  inasmuch  as  the  managers  of 
sales  are  as  a  rule  experts,  have  access  to  facts  pertaining 
to  cattle  more  than  the  ordinary,  and  are  responsible  for 
creating  an  atmosphere  of  stimulation  and  enthusiasm  in  the 
course  of  the  sale  that  easily  carries  people  past  their  best 
judgment,  and  in  further  consideration  of  the  fact  that 
many  purchasers  are  neither  experts  as  to  cattle  nor  thor- 
oughly informed  as  to  the  basis  of  values  as  represented  by 
pedigiee  and  record,  it  is  incumbent  upon  the  management 
to  protect  the  ordinary  buyer  b}^  eveny^  safeguard  and  assur- 
ance which  can  reasonably  be  invoked. 

The  sales  management  which  can  create  in  the  minds  of 
the  public  a  sense  of  security  as  to  the  integrity  of  the  sale 
will  in  the  long  run  outstrip  any  management  of  questionable 
integrity,  no  matter  what  the  offerings  of  such  management 
may  be. 

There  may  ver\'  well  be  a  difference  of  opinion  as  to  the 
type  of  cattle  which  ought  to  be  off'ered  for  sale.  It  is  not 
my  purpose  to  discuss  the  type  so  far  as  it  is  represented 
by  appearance,  a  matter  which  is  obvious  and  largely  a 


476  HENR  Y    B  AI  RD     F  A  VILL 

matter  of  taste.  But  when  it  comes  to  the  deeper  facts 
related  to  animals,  their  history  as  individuals  or  in  the 
herd,  there  are  certain  stipulations  which  every  management 
should  set  for  itself  and  to  which  it  should  demand  that  its 
consignors  freely  subscribe.  Although  as  a  rule  the  sales 
management  can  not  be  held  legally  responsible  for  misrep- 
resentations as  to  the  character  of  cattle,  it  is  in  position 
so  to  determine  the  facts  as  to  lead  them  to  exclude  animals 
which  are  under  suspicion. 

There  are  several  factors  as  to  the  physical  make-up  of 
animals  which  must  be  regarded  as  vital. 

First,  Tuberculosis:  It  is  noteworthy  that  arguments 
which  a  few  years  ago  it  was  necessary  to  put  forth 
and  strongly  maintain  on  the  subject  of  tuberculosis  in 
cattle  are  now  superfluous.  Practically,  the  discussion  as 
to  the  seriousness  of  this  question  has  ceased.  Everybody 
acknowledges  its  enormous  importance.  Questions  of  meth- 
ods are  still  before  us  for  decision,  but  that  it  is  a  problem 
to  be  attacked  at  every  angle  is  beyond  question,  and  that 
it  is  hopeful  of  solution  is  largely  demonstrated  by  the  tre- 
mendous improvement  which  we  in  this  State  can  see  in 
the  few  years  in  which  active  measures  have  been  pursued. 
Nevertheless  the  day  has  not  passed  when  tuberculous  cattle 
will  be  offered  at  public  sale,  and  that  with  a  full  knowledge 
on  the  part  of  consignors  and  often  with  a  full  knowledge  on 
the  part  of  the  sale  management. 

There  is  no  language  strong  enough  to  condemn  this 
situation.  It  is  not  an  occasional  occurrence,  it  is  a  very 
common  occurrence,  and  public  opinion  must  be  so  focussed 
upon  it,  and  the  character  of  the  transaction  as  to  its  com- 
mercial dishonesty  must  be  so  indelibly  stamped,  that  any 
departure  from  the  straight  course  on  the  part  of  either 
consignor  or  management  should  be  sufficient  utterly  to 
destroy  confidence  in  both. 

This  is  not  simply  a  matter  of  dishonesty  in  the  individual 
transaction,  it  is  a  matter  of  treason  to  the  whole  livestock 


AG  RI  C  U  LT  IJ  R  IC     A  N  F)     F)  A  T  R  Y  I  N  G  477 

enterprise,  [uul  individn.'i.ls  who  can  not  sec  without  pressure 
the  importance  of  the  matter  should  be  made  to  feel  it  by 
every  penalty,  legal  or  moral,  that  the  public  can  apply. 

The  most  important  factor  in  determining  the  reliability 
of  tliis  transaction  is  the  integrity  which  includes  the  capac- 
ity of  the  official  tester.  The  accredited  veterinary  who  can 
be  bought  or  influenced  is  worthy  of  not  the  slightest  confi- 
dence in  what  he  presents.  The  business  is  full  of  instances 
of  conscientious  testers  who  are  not  acceptable  because  of 
their  unflinching  adherence  to  facts.  It  is,  of  course, 
equally  full  of  instances  of  men  who  are  preferred  for  these 
purposes  because  they  will  compromise  with  the  facts. 

There  is  but  one  solution  to  this,  and  that  is  the  deter- 
mination by  the  management  as  to  who  are  capable  and 
honest  men  and  the  insistence  that  all  parties  shall  measure 
up  to  the  standard  set. 

So  important  js  this  factor,  that  I  am  disposed  to  think 
that  the  transaction  should  be  made  to  turn  upon  this  test 
and  the  man  who  makes  it.  I  consequently  question  the 
advisability  of  selling  cattle  subject  to  retest  in  ninety  days, 
or  any  similar  period. 

There  should  be  a  limit  to  the  liability  of  a  seller.  If 
he  is  presenting  cattle  which  he  believes  to  be  sound,  backed 
by  veterinary  examination  which  he  and  all  others  believe 
to  be  honest,  the  liability  should  terminate  at  that  point, 
rather  than  be  dependent  upon  subsequent  retest.  The 
guarantee  for  a  period  of  time  tends  to  lessen  the  vital  im- 
portance of  the  primary  test,  and  I  believe  the  importance  of 
the  primary  test  should  be  emphasized  to  its  fullest  extent. 

In  case  fraud  can  be  shown  as  having  entered  into  the 
primary  test,  the  buyer  has  as  full  legal  recourse  as  though 
there  were  an  extended  guarantee,  but  it  has  seemed  to  me 
that  the  extended  guarantee  is  nothing  but  an  advertising 
makew^eight  and  that  it  has  not  at  bottom  sufficient  justice 
to  make  it  a  primary  stipulation,  as  a  rule,  in  the  sale. 

When  the  management  of  a  sale  takes  an  unequivocal 


478  HENRY     BAIRD     FA  V  ILL 

stand  upon  this  question  of  tuberculosis  and  demands  that 
there  should  be  no  suggestion  of  quibble,  and  if,  in  addi- 
tion, it  exposes  for  public  scrutiny  the  cattle  test  papers  of  a 
fully  accredited  tester,  it  has,  in  my  judgment,  performed 
its  full  duty.  Devices  of  an  extraordinary  nature,  in  the 
way  of  guarantees  which  are  not  sufficiently  sound  to  be- 
come universal,  weaken  rather  than  strengthen  the  general 
proposition. 

Second,  Contagious  Abortion:  No  single  calamity  can 
befall  a  herd  as  important  in  its  immediate  bearings  as 
contagious  abortion.  This  subject  is  fraught  with  utmost 
seriousness  and  difficulty.  Contagious  abortion  is  extreme- 
ly widespread  in  the  dairy  world.  All  of  the  older  dairy 
regions  are  more  or  less  permeated  with  it.  Practically  no- 
body escapes  it  indefinitely,  and  the  immediate  loss  in- 
volved, together  with  the  extreme  difficulty  and  uncertainty 
of  its  management,  place  it  as  one  of  the  calamities  to  which 
the  breeder  is  subject.  Fortunately,  it  is  for  the  most  part 
a  self -limited  trouble.  All  experienced  men  are  familiar 
with  its  outbreaks  and  are  familiar  with  the  fact  that 
spontaneously,  in  the  course  of  two  or  three  years,  it 
clears  up. 

It  is  not  my  purpose  to  discuss  its  nature  or  its  manage- 
ment. It  is  my  purpose  to  insist  that  the  man  who  inten- 
tionally puts  into  a  sale,  or  the  management  which  know- 
ingly permits  in  a  sale  an  animal  actively  carrying  conta- 
gious abortion,  is  a  criminal. 

The  practical  application  of  this  idea,  however,  is  not 
entirely  simple.  Although  it  is  perhaps  true  that  scientific 
methods  can  determine  contagious  abortion  from  acci- 
dental abortion,  these  methods  are  not  sufficiently  recog- 
nized and  the  facilities  for  using  them  not  sufficiently  wide- 
spread to  make  it  thus  far  a  practical  safety.  The  least, 
however,  that  can  be  demanded  is  that  the  facts  with 
reference  to  a  cow  shall  be  stated.  If  she  has  calved  abnor- 
mally, or  failed  to  calve,  or  if  there  is  any  other  phase  of  her 


A  C.  K  T  f  IJ  I.  T  U  R  K      AND     DAI  R  V  I  N  G  479 

breeding  that  is  open  to  question,  the  facts  should  be  de- 
manded by  the  management  of  the  sale  and  fully  set  forth. 

With  all  the  facts  presented  to  the  public,  it  is  reasonable 
to  agree  thai  the  buyer  may  estimate  his  risks  and  take  his 
chances,  but  without  a  full  statement  of  the  facts,  the  most 
expert  buyer  is  without  any  protection  and,  if  subjected  to 
the  risk,  which  he  would  not  naturally  assume,  he  is  the  vic- 
tim of  contemptible  fraud. 

Bear  in  mind,  this  is  not  a  simple  question  of  an  honest 
transaction.  It  is  a  question  of  reliability  of  an  institution 
which  we  are  trying  to  build  up  for  the  purpose  of  promoting 
this  greatest  of  industries,  and  anything  which  tends  to 
weaken  its  foundations  is  treachery  to  the  whole  industry. 

In  addition  to  the  foregoing,  most  of  the  questions  as 
to  constitution  and  as  to  other  peculiarities  of  the  dairy 
cow  are  reasonably  subject  to  judgment  from  inspection. 

There  are,  however,  specific  flaws  as  to  feeding  peculi- 
arities and  milking  peculiarities  which  can  not  be  known 
except  by  experience.  In  a  private  transaction,  it  is  a  simple 
question  of  honest  dealing.  In  a  public  sale  it  is  proper  that 
these  matters  should  be  made  the  subject  of  the  most  careful 
inquiry  and  discrimination  by  the  management.  There 
are  limits  to  what  a  management  can  find  out  and  know. 
There  are  questions  as  to  what  the  motive  of  a  consignor 
may  be,  but  accepting  all  of  those  qualifications,  it  is  per- 
fectly sound  sense  to  demand  that  every  defect  which  a 
management  can  determine  in  advance  shall  be  specifically 
set  forth  before  a  sale  is  consummated. 

It  may  be  objected  that  in  making  these  demands  we 
are  establishing  an  unreasonable  standard  of  guaranty ;  that 
after  all,  a  public  sale  is  not  for  the  purpose  of  furnishing  a 
market  and  not  for  the  purpose  of  protecting  its  buyers. 

My  answer  to  this  is  twofold :  First,  that  it  is  not  a  nor- 
mal market  but  a  strictly  artificial  market  to  which  the  pub- 
lic is  attracted  by  the  character  of  the  management  and  the 
reputation  of  the  community.     The  buyer  and  seller  are  not 


48o  HENRY     BAIRD     FAVILL 

upon  equal  terms,  but  by  reason  of  the  rapidity  of  the  trans- 
actions and  various  features  inherent  in  the  auction  business, 
opportunity  for  careful  examination  and  mature  judgment 
are  lacking,  and  in  a  transaction  where  definite  knowledge 
and  deliberate  plans  are  on  one  side,  and  hasty  impressions 
and  competitive  bidding  on  the  other,  every  possible  means 
whereby  the  parties  to  the  transaction  can  be  put  upon  an 
equal  footing  as  to  foundations  for  judgment,  must  be 
reasonable  to  demand.  Moreover,  public  sales  are  depen- 
dent upon  buyers  and  buyers  are  not  indefinitely  gullible. 
In  the  long  run  the  public  sale  will  be  a  permanent  institu- 
tion just  in  proportion  to  the  safety  which  buyers  may  feel 
in  regard  to  the  fundamental  honesty  of  the  sale. 

Although  this  argument  appears  to  be  for  the  benefit  of 
the  buyer,  a  moment's  reflection  shows  that  ultimately  it  is 
the  salvation  of  the  seller. 

A  man  who  conducts  a  farm,  sells  his  produce  to  his  herd 
for  the  purpose  of  selling  his  increase  at  their  full  value, 
needs  a  reliable,  economical,  stable  market. 

It  is  a  prevailing  opinion  that  the  public  sale  at  stated 
intervals  will  furnish  that  market,  but  I  go  back  to  my 
original  proposition,  that  the  essence  of  that  market  is  its 
character;  that  the  strength  of  it,  is  confidence;  that  the  test 
of  it,  is  experience. 

There  are  other  factors  with  regard  to  the  public  sale 
of  great  importance,  though  perhaps  less  essential. 

First  of  these,  I  would  enumerate  mercantile  squareness. 
Shall  a  man  be  permitted  to  bid  against  his  own  cattle  even 
indirectly?  By-bidding  is  generally  condemned  as  a  dis- 
honest practice.  Where  it  is  secretly  done  it  is  distinctly 
fraudulent.  Has  it  been  eliminated  from  our  public  sales? 
Every  one  who  is  familiar  with  it  knows  that  not  only  has 
it  not  been  eliminated,  but  that  variations  of  by-bidding, 
in  the  way  of  elaborate  schemes  for  increasing  values,  have 
happened  to  a  scandalous  extent.  Can  the  business  end  of 
the  public  sale  survive  this  crookedness? 


A  G  R  I  C  U  L  T  TJ  R  E      AN  I)     T)  A  I  K  V  I  N  (^  481 

II  mailers  iiol  liow  liij^h  Ihc  r|nalily  of  the  offerings,  nor 
how  ^rcal  Ihc  rcpulalion  of  Ihc  sales  management,  a  deal 
which  is  commercially  crooked  tends  to  ruin  the  business, 
and  there  is  but  one  remedy  for  il,  which  is  publicity. 

Many  other  things  I  might  take  up  of  minor  importance. 
The  preparation  of  cattle  for  sale,  their  sanitary  surround- 
ings, and  all  the  ordinary  factors  of  good  management, 
but  lack  of  time  forbids  me  to  go  inUj  them. 

I  have  chosen  to  concentrate  my  attention  upon  the  pub- 
lic sale,  in  the  belief  that  it  is  an  institution  of  value.  Influ- 
ential breeders  are  not  all  satisfied,  however,  that  it  is  for 
them  desirable. 

Here  and  there,  public  sales  by  individual  breeders  will 
be  held.  This,  however,  does  not  apply  to  the  rank  and  file 
of  the  industry.  The  majority  of  breeders  are  dependent 
either  upon  private  sale  or  the  consignment  sale. 

For  many  reasons  the  consignment  sale  is  preferable. 
The  simple  question  is,  can  it  be  made  trustworthy?  I 
have  sufficiently  indicated  the  obligation  which  seems  to 
me  to  rest  upon  the  managers  of  the  sale.  Square-dealing 
men  will  need  no  pressure.  Human  nature,  however,  is 
to  be  reckoned  with.  The  ultimate  control  in  this  matter 
will  rest  with  the  consumer  —  the  purchasing  public.  The 
key  to  the  matter  is  publicity.  Let  us  not,  as  farmers  and 
breeders,  quietly  submit  to  repeated  imposition. 

If  a  sale  is  of  high  standard,  honest  as  to  quality  and 
methods,  let  it  be  strongly  patronized. 

If  a  sale  is  questionable  in  its  methods,  let  it  be  shunned. 
Let  us  call  a  spade  a  spade  and  justify  ourselves  in  the  denun- 
ciation of  that  which  is  untrustworthy,  not  onh^  upon  abstract 
grounds  of  morality,  but  wdth  that  enlightened  selfishness 
that  leads  us  to  see  that  the  relationship  between  the  success 
of  our  operations  and  our  market  is  immediate  and  vital. 
17 


482  HENRY     BAIRD     FAVILL 


Delivered  in  connection  with  the  presentation,  by  the  American  Guernsey 
Cattle-  Club,  of  a  portrait  of  William  Dempster  Hoard  to  the  Saddle 
and  Sirloin  Club,  on  the  evening  of  October  29,  1914,  in  the 
Banquet  Hall  of  the  Stock  Yards  Inn,  Chicago. 

Printed  specially. 

ACCEPTANCE   OF   EX-GOVERNOR   HOARD'S 
PORTRAIT 

IF  there  is  great  hesitation  on  my  part  in  accepting 
so  agreeable  a  duty  and  so  noticeable  a  distinction  as 
is  offered  me  this  evening,  there  is  a  reason,  and  the 
reason  is  a  sense  of  inadequacy,  a  sense  of  distrust  in  my 
ability  to  walk  just  the  line  that  I  ought  to  walk  in  this 
matter.  If  I  were  to  say  all  that  is  in  my  heart  to  say 
on  this  subject,  I  would  say  too  much,  and  if  I  say  only 
enough  for  the  occasion,  I  shall  not  have  said  half  the  truth. 
My  feelings  in  this  matter  are  deeply  personal,  as  well 
as  merely  official.  I  have  traditional  relation  to  Governor 
Hoard,  born  with  respect  and  affection  for  him — family 
tradition,  iieighborhood  tradition.  I  may  say,  incidentally, 
that  he  was  an  intimate  companion  of  my  father's  gener- 
ation, of  his  brothers  particularly.  Two  of  my  father's 
brothers,  with  Governor  Hoard,  and  four  others,  formed 
the  first  Dairymen's  Association  of  Wisconsin.  Soon  after 
that — not  so  soon,  but  while  I  was  hardly  more  than  a  boy  ■ — 
I  became,  when  Governor  Hoard  was  first  elected  Governor, 
his  family  physician.  The  relationship  was  not  that  of 
physician  and  patient,  it  was  that  of  a  young  man  deeply 
impressed  with  the  valuable  friendship  of  an  older  man, 
and  Governor  Hoard  is  one  of  the  few  men  I  have  ever  seen 
with  whom  I  could  associate  half  an  hour  at  any  time  and 
always  learn  something.  And  so,  as  time  went  on,  and  I 
traveled  along  in  that  commonwealth,  more  or  less  inti- 
mately with  Governor  Hoard,  and  always  with  my  eyes 
fixed  upon  his  career,  I  have  seen  him  take  a  position  in 


A  (;  R  I  C  ULTU  R  FC      AND      F)  A  I  R  Y  I  N  fi  483 

that  commonwealth  politically  at  that  time — that  was 
always  significant.  I  have  seen  his  triumj)hs  and  I  have 
seen  his  failure,  if  one  may  so  call  it,  politically,  always  on 
the  basis  of  principle.  And  the  only  defeat  that  he  ever 
had  was  a  defeat  upon  principle.  And  so,  as  the  time  went 
on  and  I  grew  older  and  grew  away  from  that  locality, 
always  that  friendship  has  been  maintained,  always  that 
relationship.  So  you  can  see  that  I  come  to  this  situation 
with  a  sense  of  personal  interest  that  few  people  could  have. 

In  more  recent  years,  as  my  interests  came  to  be  changed, 
and  I  began  to  have  a  fundamental  and  increasingly  deep 
interest  in  agricultural  affairs,  I  saw  that  all  my  early 
estimate  of  Governor  Hoard  was  far  short  of  its  true  level. 
I  began  to  see,  as  I  came  to  figure  the  various  things  that  go 
on  in  this  country,  that  although  we  had  in  Wisconsin 
statesmen,  men  of  affairs,  men  of  breadth,  and  power,  and 
influence,  and  insight,  that  most  of  them  were  really  super- 
ficial in  comparison  wath  Governor  Hoard;  that  the  states- 
manship of  Governor  Hoard,  as  Mr.  Marsh  has  so  aptly 
stated,  just  outside  of  the  limelight,  was  the  statesmanship 
of  our  foundation;  that  whereas  other  men  were  dealing 
with  the  framework  of  our  social  structure,  he  was  dealing 
with  its  sources,  its  foundations,  its  cornerstones.  And  so, 
as  my  familiarity  with  his  work  increased,  and  as  I  came 
more  and  more  to  follow  the  lines  of  his  influence  every 
year,  I  have  come  to  see  more  fully  that  his  influence  is  not 
to  be  measured  by  Wisconsin,  not  to  be  measured  by  the 
borders  of  the  West,  not  to  be  measured  by  the  confines  of 
the  United  States,  but  that  his  influence  has  reached  the 
world  around,  wherever  a  community  is  sufficiently  enlight- 
ened to  realize  that  agriculture  is  its  foundation  and  where- 
ever  it  is  sufficiently  specialized  to  see  that,  of  all  the  branches 
of  agriculture,  dairying  is  the  most  important. 

Therefore,  I  have  come  to  feel  with  regard  to  Governor 
Hoard  that  he  is  a  man  of  the  broadest  statesmanship,  and 
I  have  yet  to  know,  in  casting  over  in  my  mind  all  of  the 


484  HENRY     BAIRD     FAVILL 

public  figures  of  this  country,  I  have  yet  to  reahze  a  man 
whose  influence  upon  the  welfare  of  this  country  has  been 
greater  than  that  of  Governor  Hoard. 

That  being  the  case,  the  question  is  always  before  us, 
how  has  he  done  it?  and  I  say  he  has  done  it  by  devotion 
to  a  cause;  he  has  done  it  by  patience,  insistence,  dogged 
determination  to  go  on  and  on  until  he  accomplished  what 
he  was  at,  and  never  has  he  compromised.  And  so,  although 
we  can  see  in  this  same  agricultural  world  and  although  we 
can  see  in  the  dairy  world  great  figures,  men  of  great  in- 
fluence and  great  power,  after  all,  here  is  the  man  who  has 
carried  the  key  to  the  recesses  of  the  closed  mind  in  this 
country.  He  is  the  man  who  has  carried  the  torch  that 
has  fired  men's  souls,  and  this  is  the  man  that  we  must 
acknowledge  as  leader  in  the  whole  realm  of  agriculture 
and  dairying  thought  in  the  world. 

The  Saddle  and  Sirloin  Club  honors  itself  in  accepting 
for  a  place  upon  its  walls  this  portrait.  Always  it  has  held 
in  highest  esteem,  in  great  appreciation,  Governor  Hoard. 
Only  now  has  it  come  to  the  point  where  it  includes  his 
portrait  in  its  gallery. 

You  may  wonder  why  it  should  be  interested  in  a  por- 
trait for  its  gallery.  The  Saddle  and  Sirloin  Club  is  not  a 
mere  social  convenience.  It  is  more  than  that,  it  is  a  clear- 
ing house  for  agricultural  thought,  and  more  than  that  it 
is  an  educational  institution.  Thanks  to  the  great  vision 
and  insight  and  inspiration  of  Mr.  R.  B.  Ogilvie,  who  is 
really  the  father  of  the  Club  and  the  originator  of  the  idea 
of  the  gallery  such  as  we  have,  this  movement  has  gone  on 
and  on,  not  as  a  decorative  feature,  but  as  a  feature  of 
perpetual  education  to  the  breeders  and  the  agricultural 
men  generally  in  this  country,  with  the  hope  that  it  will  go 
on  and  on  and  that  its  usefulness  as  an  educational  feature 
has  only  just  started.  For  that  reason,  the  Club  welcomes 
the  gift  of  the  American  Guernsey  Club  of  this  portrait  of 
Governor  Hoard  and  receives  it  with  gratitude  and  thorough 


A  (;  K  I  (' n  LI  n  u  I-:    and    daihyinc;         485 

enthusiasm,  feeling  that  no  jjlacc  that  is  filled  by  a  pf>rtrait 
upon  its  walls  will  he  more  distinguished,  more  hij^hly' 
honored,  more  absolutely  appreeiated  in  the  future  of  our 
great  industry  than  will  this  place  in  which  appears  the 
portrait  of  Governor  Hoard,  and,  on  behalf  of  the  Club,  I 
have  to  extend  to  you  our  heartfelt  thanks.* 

*  Through  the  generosity  of  Mr.  John  A.  Spoor,  an  excellent  portrait  of 
Dr.  Favill,  painted  by  Mr.  Arvid  Nyholm,  was  presented  to  the  Saddle  and 
Sirloin  Club  in  the  suinnicr  of  i<;iO,  and  hangs  in  its  gallery. 


486  HENRY     BAIRD     FAVILL 


Delivered  before  the  Eighteenth  Annual  Conference  of  Agricultural 
Extension  Workers,  Purdue  University,  LaFayette,  Ind.,  Novem- 
ber 22,    I9I4. 

PROBLEMS   OF   THE    DAIRY   INDUSTRY 

IT  is  a  very  great  pleasure  and  privilege  for  me  to  be 
here  to-day.  I  almost  hesitate  to  follow  the  logic 
of  Professor  Hunziker  and  the  enthusiasm  of  Pro- 
fessor Christie,  for  fear  of  spoiling  it,  but  the  situation 
needs,  more  than  anything  else,  inspiration,  and  inspira- 
tion is  made  up  of  ideals,  imagination,  and  energy,  and 
these  have  been  presented  to  you  to-day  in  these  talks  in 
such  a  way  as  almost  to  make  it  desirable  that  you  shall 
go  away  and  think  about  what  has  been  said  to  you 
already,  without  further  comment. 

I  have  not  been  given  any  special  subject  to-day.  I 
was  told  to  say  what  I  wanted  to  say.  It  is  a  very  danger- 
ous thing  to  have  said  that,  for  there  is  so  much  I  want  to 
say.  I  probably  have  taken  my  professional  life  in  my 
hands  in  coming  here,  as  I  frequently  do.  I  have  depended 
on  the  fact  that  I  am  a  doctor,  for  a  livelihood.  I  have  had 
friends  that  were  frank  enough  to  say  that  that  was  prob- 
ably the  reason  I  was  a  farmer  on  such  a  scale,  because  I 
was  a  doctor.  Be  that  as  it  may,  when  I  registered  with 
the  young  lady  to-day  who  gave  me  the  card,  I  wrote  down, 
"Occupation  —  Physician.  Chief  Interest — Agriculture." 
How  is  that  going  to  sound  in  my  practice?  I  do  not  see 
that  there  is  anything  to  do  but  face  it.  Perhaps  I  am 
excusable  because  I  am  a  pretty  old  man  in  the  practice 
of  medicine,  and  perhaps  it  is  time  that  I  should  get  out. 

The  fact  remains,  however,  that  my  chief  interest,  as 
far  as  human  interest  lies,  is  in  agriculture.  That  is  why 
I  am  a  dairyman,  because  I  see,  or  think  I  see  that  the  future 
of  agriculture,  which  means  the  future  of  this  people,  is  to 
a  very  great  extent  bound  up  in  the  subject  of  dairying. 


ACIRI  CULTURE     AND     DAIRYING  487 

Now,  you  know  llial,  all  of  you.  A  very  large  percentage 
of  the  people  with  whom  you  come  in  contact  know  that. 
You  do  not  have  to  have  me  talk  here  about  rejuvenation 
of  our  work  out  in  the  wheat  fields  h)y  means  of  stock  rais- 
ing and  particularly  dairy  cattle  raising.  You  do  not  need 
me  to  point  out  the  watsefulness,  the  unthinking  blunder- 
ing along  the  line  of  depressed  fertility.  You  know  that. 
But,  my  friends,  bear  in  mind  that  the  people  at  large  do 
not  know  that.  Intelligent  farmers  know  it,  semi-intelli- 
gent farmers  respect  it,  but  the  mass  of  people  that  make 
up  public  opinion  in  this  country  do  not  know  it. 

The  simple  question  before  us  is,  how  are  they  going  to 
know  it  and  what  is  our  function,  yours  and  mine,  with 
reference  to  the  dissemination  of  that  information  so  broad- 
ly, so  effectively  as  to  make  it  the  conviction  of  the  American 
people  that  what  they  regard  as  their  greatest  asset,  name- 
ly, their  agricultural  preeminence,  can  be  conserved  only 
through  the  legitimate  development  of  their  stock  hus- 
bandry, and  particularly  their  dairy  husbandry.  How  are 
we  going  to  bring  it  home  to  them  so  that  all  the  people 
know  what  you  and  I  know?  Until  all  the  people  in 
some  degree  know  enough  at  least  to  mold  public  affairs, 
we  are  in  jeopardy. 

That  is  why  it  is  worth  our  while  to  round  up  once  in  a 
while  and  re-awaken  our  consciences,  wake  ourselves  up, 
not  as  to  what  we  know,  but  as  to  the  degree  of  influence 
it  is  incumbent  upon  us  to  exercise  upon  this  subject.  How 
do  I  know  that  people  do  not  realize  this  thing?  In  a 
general  way  we  all  know  it,  but  take  some  specific  instance. 
Did  you  ever  try  to  talk  to  a  man  who  does  not  know  any- 
thing in  particular  about  the  subject  of  oleomargarine? 
He  never  fails  to  make  the  statement,  "You  do  not  want 
competition."  That  is  the  attitude  of  the  general  public 
on  the  subject  of  oleomargarine.  I  am  not  now  discussing 
whether  it  is  good,  bad,  or  indifferent  as  a  food.  The  atti- 
tude of  the  average  business  man  is  that  the  dairy  interest 


488  HENRY     BAIRD     FA  V  ILL 

in  this  question  is  a  selfish  interest  of  competition.  Until 
that  average  business  man  can  be  made  to  see  that  the 
future  of  this  country  lies  in  its  agriculture,  that  the  future 
of  agriculture  lies  in  its  dairying,  that  the  future  of  dairy- 
ing lies  in  an  honest,  unhampered  market,  without  the 
handicap  of  illegitimate  competition,  mind  you,  I  say 
illegitimate  competition,  until  the  average  business  man  can 
see  that  clearly,  the  dairy  business  is  in  danger,  agriculture 
is  in  danger,  and  the  people  are  in  danger.  It  is  a  question 
of  national  preservation.  You  understand  that.  Does  the 
public  understand  it?  If  the  public  does  not  understand 
it,  whose  fault  is  it?  It  is  yours  and  mine,  and  it  is  of 
fundamental  importance  that  they  know  of  the  only  way 
in  which  our  agriculture  can  be  preserved. 

I  am  going  to  pass  those  generalizations  as  to  the  im- 
portance of  dairying.  I  am  simply  calling  your  attention 
to  the  fact  that  it  is  your  duty  to  disseminate  this  conception 
of  the  bigness,  the  importance,  the  vital  character  of  this 
question  to  the  American  people.  When  you  come  to  that 
proposition,  the  question  of  trade  competition  and  selfish 
interest  fades  away  in  the  enormous  values  that  are  inherent 
in  the  fundamental  question  of  national  prosperity. 

There  are  other  things  that  I  want  to  speak  about  just 
in  passing,  and  one  is  with  regard  to  the  character  of  farm- 
ing operations  of  various  kinds.  I  am  not  coming  here  to 
throw  any  kind  of  discredit  upon  the  co-called  "grain 
farmer."  I  do  not  know  where  we  would  be  without  the 
grain  farmer,  or  any  other  class  of  farmer,  but  I  want  to 
call  your  attention  to  the  logic  and  the  psychology  in  the 
farming  business,  in  a  measure.  Any  business  gains  in 
its  intellectual  returns,  in  its  interests,  in  its  attractiveness, 
just  in  proportion  to  its  complexity  and  just  in  proportion 
to  the  amount  of  mental  effort  that  it  takes  to  handle  it. 
When  you  introduce  into  the  question  of  farming,  the 
element  of  superior  intelligence,  the  element  of  plan,  the 
element    of   purpose,    of    long-continued    intellectual    and 


A  (;  R  I  C  U  L  T  U  R  E      AND     DAIRYING  4S9 

persistent  line  of  effort,  just  the  minute  you  put  a  business, 
farming  or  any  other  business,  on  this  basis,  just  that  minute 
you  begin  to  make  it  attractive  to  the  people  that  have 
money.  Just  as  long  as  it  takes  a  mind  to  run  a  business, 
it  will  attract  other  minds  to  it,  and  the  future  of  agricul- 
ture is  right  now  playing  before  me. 

We  are  on  the  verge  of  the  age  when  the  great  intellec- 
tual pursuit  of  this  country  is  agriculture.  I  know  it,  and 
you  know  it  if  you  have  thought  of  the  various  phases  of 
the  subject.  It  takes  more  money,  more  plans,  more 
courage,  more  imagination  and  inspiration  to  be  a  dair>''- 
man  than  to  be  any  other  kind  of  a  farmer,  and  that  is  why 
it  is  to  be  so  preeminent  as  a  phase  of  farming  in  the  future. 

There  is  another  thing  that  I  want  to  call  your  atten- 
tion to  outside  of  that.  It  has  been  mentioned  here  to-day 
that  farm  living  conditions  are  an  important  considera- 
tion. They  are  of  vital  importance.  I  have  had  interests 
a  little  outside  of  this,  at  least  from  another  angle.  The 
National  Education  Association  has  assumed  within  the 
last  few  years  the  responsibility  for  the  hygiene  of  the 
schools,  and  in  looking  over  the  field,  it  has  settled  upon 
the  question  of  rural  sanitation,  the  question  of  sanitation 
of  the  rural  schools,  as  the  thing  most  in  need  of  attention. 
When  you  consider  the  vast  body  of  teachers  that  are 
involved,  and  the  vast  number  of  children  involved,  it  is  a 
vital  question.  Unless  they  get  the  cooperation  of  the  dis- 
trict, unless  they  get  the  cooperation  of  the  individual  farm- 
ers, and  unless  they  get  the  cooperation  of  the  individual 
farmers'  wives,  they  are  not  going  to  be  able  to  accomplish 
this  tremendously  needed  reform  in  the  way  of  sanitation  of 
country  schools.  It  comes  down  to  the  question  of  social 
leaders  in  the  rural  community.  It  comes  down  to  ha\'ing 
somebody  to  point  the  way.  There  is  nobody  so  in  position 
to  enter  into  this  particular  phase  of  the  proposition  dealing 
w4th  the  well-being  of  the  farming  community  as  the  County 
Agent.     The  County  Agent  is  to  be  the  solution  of  many 


490  HENRY     B  A  I  R  D     F  A  V  I  L  L 

difficulties  and  priman'-  among  these  difficulties  is  getting 
into  action  the  obviousty  good  but  dormant  motives  that  are 
behind  the  country  community.  It  is  the  County  Agent 
or  somebody  corresponding  to  him,  that  the  National 
Education  Association  must  look  to  for  the  effective  touch, 
just  as  it  is  absolutely  proved  that  the  Agricultural  Experi- 
ment Stations  must  look  to  the  County  Agents  for  the  final 
translation  and  interpretation  of  the  results  of  their  work 
in  the  minds  of  the  people. 

For  there  is  no  class  in  better  position  to  appreciate  the 
very  essential  principles  of  living  conditions,  good  hygiene, 
sanitary  things  involved  in  their  operations,  the  way  they 
produce  their  milk,  the  way  they  rear  and  keep  their  ani- 
mals, the  way  they  feed  them,  and  the  way  they  keep  their 
animals  from  disease.  All  of  these  questions  concentrate 
their  minds  on  health  and  wholesomeness.  That  is  the 
kind  of  a  community  which  is  going  to  make  the  greatest 
advance  in  regard  to  sanitation  and  health. 

There  is  another^  side  of  this  dairy  question  which  I 
must  call  attention  to.  You  would  think  from  the  fact 
that  everyone  uses  milk  in  some  degree  or  other,  that  every- 
body uses  butter  in  some  degree  and  a  good  many  people 
use  cheese,  that  the  understanding  of  the  people  as  to  the 
value  of  dairy  products  was  pretty  well  established.  You 
would  think  that  they  knew  about  this  value  and  that  they 
are  probably  in  harmony  with  that  situation.  Well,  nothing 
is  farther  from  the  truth  than  that.  So  far  as  the  use  of 
dairy  products  is  concerned,  the  people  of  this  country  have 
not  yet  crossed  the  threshold  of  intelligence.  Everybody 
uses  butter,  perhaps  not  so  much  as  he  ought  to,  and  per- 
haps this  is  an  important  question.  The  people,  however, 
that  use  milk,  do  not  use  milk  in  one  per  cent  of  the  popu- 
lation as  freely  as  they  could  use  milk  profitably  from  the 
standpoint  of  health  of  their  families. 

People  do  not  understand  about  milk.  It  is  a  matter  of 
investigation  in  my  direction  and  I  know  that  people  are 


A  (i  R  I  C  U  L  T  n  R  10     AND      I)  A  f  l<  Y  I  N  G  491 

habitually  skiriipinj^'  tlicmselves  on  milk,  under  the  general 
impression  that  it  is  expensive,  nnrler  the  general  impres- 
sion that  it  is  a  luxury.  They  are  using  milk  for  their 
little  ehildren  heeause  they  know  their  need,  hut  they  are 
regarding  it  all  the  time  as  a  luxury.  Now,  you  know,  and 
I  know  that  we  need  for  the  rearing  of  any  young  animal  a 
eertain  amount  of  protein  material,  or  nitrogenous  foods. 
We  have  got  to  have  it.  Children  have  got  to  have  it  in 
order  to  make  them  grow,  just  as  animals  must  have  it. 

But,  what  are  the  children  getting  for  the  most  part 
for  their  protein  ration?  Why,  they  are  getting  a  little 
bit  of  milk  here  and  there  and  almost  anything  else  that 
will  fill  the  bill.  They  are  getting,  not  only  food  that  is 
not  good  for  them,  meat  for  example,  among  some  classes 
eggs,  etc.,  but  as  a  rule  they  are  getting  the  kind  of  protein 
that  you  buy  in  the  shop  somewhere.  I  do  not  hesitate 
to  say  from  a  medical  standpoint  that  it  is  bad  for  them. 
I  do  not  hesitate  to  say  that  the  less  meat  children  get  in 
the  early  period  of  their  lives  the  better  off  they  are.  They 
must  have  protein,  but  where  are  they  going  to  get  it? 
You  and  I  say,  milk.  The  people  say,  "What  relation  has 
milk  to  this  question?  —  we  must  give  them  strong  food," 
not  knowing  at  all  that  there  is  this  correspondence  in  nu- 
tritive value  between  milk  and  meat,  not  realizing  that 
when  they  are  giving  their  children  milk,  it  is  the  equivalent 
of  meat,  except  that  they  are  giving  them  something  better 
for  them. 

Milk  as  a  food  in  its  larger  aspect  has  not  yet  dawned 
upon  the  public.  It  is  of  paramount  importance  that  it 
be  fixed,  because  the  market  has  not  yet  been  touched  upon 
the  subject  of  the  value  of  milk.  They  say  they  can  not 
afford  it.  There,  again,  they  do  not  know.  It  is  utterty 
foreign  to  the  housewife's  mind,  the  idea  that  miUc,  unit 
for  unit,  is  cheaper  than  meat.  They  do  not  understand 
that  and  consequently  they  are  moving  along  without  any 
understanding  of  the  fundamental  relationship  of  milk  and 


492  HENRY     BAIRD     FA  V  ILL 

growth,  of  milk  that  is  open  to  them  cheap,  the  cheapest  ni- 
trogenous food  there  is,  without  any  understanding  of  the 
fact  that  they  can  bring  up  themselves  and  their  children, 
feed,  maintain,  and  grow  them  on  milk,  at  a  very  much 
cheaper  rate  than  they  can  in  any  other  way.  They  do 
not  understand  it  and  it  is  up  to  you  and  me  to  see  that 
they  do  understand  it.  It  is  a  great  deal  better  for  them. 
I  may  say  in  passing  that  the  only  known  protein  food  that 
contains  all  the  elements  necessary  for  animal  growth  is  milk. 
That  is  the  reason  to  prefer  milk  for  growing  animals. 

I  was  speaking  particularly  about  the  question  of  econ- 
omy and  that  is  beyond  any  question  to  be  found  in  the 
utilization  of  milk  instead  of  the  utilization  of  other  high- 
priced  protein  foods. 

There  is  another  side  to  this  question.  Everybody  does 
not  want  to  drink  milk  all  the  time,  and  many  do  not  realize 
that  there  is  any  other  way  to  use  milk  except  to  drink  it 
fresh.  I  am  now  coming  to  the  question  of  the  economy 
of  the  farmer  that  has  milk  from  a  few  cows  and  has  the 
product  to  dispose  of.  What  is  the  difficulty  to-day  with 
the  farmer  who  has  from  six  to  twenty  cows  that  he  milks 
twice  a  day?  I  repeat,  what  is  his  difficulty?  Is  it  not 
the  fact  that  he  has  a  perishable  product  which  he  has 
got  to  get  rid  of  then,  at  whatever  price  he  can  get  for 
it,  or  lose  it?  Is  not  that  the  fact  with  reference  to  the 
dairyman?  In  other  words,  is  it  not  the  perishability  of 
his  product?     You  must  agree  to  that. 

Now  the  question  comes,  is  there  any  way  to  meet  that 
situation?  Is  there  any  way  to  so  reduce  the  perishability 
of  milk  product  so  that  the  markets  that  are  organized  can 
not  juggle  it  out  of  existence?  We  have  got  to  meet  it. 
I  do  not  have  to  meet  it,  because  I  do  not  sell  market  milk. 
Did  you  ever  stop  to  think,  gentlemen,  that  cheese  is  the 
cold  storage  of  milk?  Did  you  ever  think  that  the  way  to 
take  the  perishability  out  of  milk  is  to  turn  it  into  cheese? 
Of  course  you  have,  but  the  people  at  large  have  never 


A  ( i  U  I  (    1 1  L  T  U  R  I-:     AND      F)  A  I  K  V  I  N  G  493 

reallv  Ihout';])!,  of  it,.  Do  they  realize  lliaL  tlicy  can  drink 
at  so  mueli  a,  r|iiarl,  a,n(l  that,  they  can  eat  cheese  at  so  much 
a  pound?  'I'he  eonsnmi^tion  of  cheese  in  this  country  is 
nothing  to  tlie  eonsunii)tion  of  cheese  in  the  older  countries 
that  have  to  1)e  economical.  "We  are  not  usin^  cheese  as  a 
food;  we  are  using  it  as  a  dessert,  and  as  a  side  issue.  From 
the  standpoint  of  national  economics,  until  a  slice  of  cheese 
is  inserted  in  the  workingman's  basket,  instead  of  a  slice 
of  meat,  we  are  not  coming  anywhere  near  the  consumption 
of  cheese  which  we  ought  to  have. 

I  sound  as  though  I  were  making  statements  that  I 
could  not  substantiate,  but  you  know  that  what  I  say  is 
true,  and  that  the  question  is  how  to  increase  the  market 
for  milk  products,  not  of  the  fresh  variety  but  of  the  stor- 
age variety,  to  stimulate  the  mercantile  interests  of  this 
country  to  furnish  that  kind  of  storage,  so  that  the  milk 
shall  be  available,  not  24  or  36  hours  after  production, 
but  24  days,  or  six  months,  or  a  year  afterward. 

A  far  more  important  question  than  the  butter  factory 
is  the  cheese  factory  and  we  must  see  that  this  comes  to 
pass.  Well,  how  is  it  coming  to  pass?  How  are  we  going 
to  stimulate  the  people  at  large  in  the  use  of  milk  products 
on  the  basis  of  health  and  economy?  How  are  we  going 
to  do  that?  That  is  the  question.  Well,  I  will  tell  you 
something  that  is  going  on,  and  I  will  have  to  be  a  little  bit 
personal  because  it  happens  to  come  this  wa3^ 

The  National  Dairy  Council  has  brought  into  its  mem- 
bership all  the  interests  of  dairying  in  the  country,  as  the 
preamble  of  its  constitution  states,  "all  of  the  interests 
dependent  on  the  dairy  cow."  Now,  what  does  that  mean? 
It  means  the  milk  dealer,  the  milk  producer,  all  the  butter 
interests,  all  the  cheese  interests,  and  all  the  condensed  milk 
interests.  Is  that  all?  Not  by  an}^  means,  that  is  the 
smallest  part  of  them.  It  means  all  the  machinery  interests, 
all  the  feed  interests,  all  of  the  people  who  are  furnishing 
equipment  for  the  dairy  barns,  and  before  you  get  through 


494  HENRY     BAIRD     FAVILL 

wdth  it,  you  will  find  incorporated  the  largest  single  inter- 
est in  the  country  to-day  represented  in  this  organization, 
known  as  the  National  Dairy  Council.  They  are  all  in. 
You  can  see  how  important  it  is  without  very  much  dis- 
cussion, to  get  all  of  those  interests  together.  You  can  see 
that  hitherto  they  have  more  or  less  been  pulling  apart, 
cutting  each  other's  throat,  and  there  has  always  been  a 
more  or  less  strenuous  feeling  between  them  and  that  it  is 
of  the  utmost  importance  to  get  them  together. 

Now,  what  is  the  first  move  they  are  going  to  make? 
Here  and  there  their  efforts  go  out  individually,  but  the 
first  move  they  are  going  to  make  is  this:  a  systematic, 
well-planned,  nation-wide  campaign  of  advertising  for  the 
purpose  of  increasing  the  use  of  milk  products.  That  is 
the  first  effort  that  is  going  to  be  made  by  this  new  Council ; 
an  effort  to  increase  the  appreciation  and  hence  the  use  of 
milk  products.  Those  who  know,  who  have  followed  the 
history  of  advertising  campaigns,  particularly  with  refer- 
ence to  food  products,  believe  that  the  use  of  milk  prod- 
ucts,— raw  milk  or  commercial  milk,  butter,  condensed 
milk,  ice-cream,  milk  powder,  and  all  of  the  things  that  are 
legitimate  milk  products, — can  be  increased  from  50  to 
100  per  cent  by  a  compaign  af  education,  by  a  campaign 
of  advertising,  setting  forth  the  facts  as  they  are,  so  plainly, 
so  broadly,  and  so  insistently,  that  everybody  can  see  what 
we  see  and  nobody  will  be  without  that  information. 

If  that  is  true, — if  it  is  true  that  publicity  can  bring 
the  use  of  milk  and  its  products  into  such  prominence  that 
it  will  spring  forward  in  demand,  what  are  we  going  to  do 
to  meet  this?  We  are  going  to  meet  the  keenest  milk 
market,  the  keenest  demand  for  milk  products  that  has 
ever  been  known  in  this  country.  The  dairy  business  is 
going  to  be  established  as  has  never  before  been  equalled, 
and  we  believe  that  it  can  be  done.  That  is  the  future  of 
the  dairy  business.  A  campaign,  not  of  farmers  or  the 
Institute  workers  who  know  it  all  now,  but  the  campaign 


AGRICULTURE     AND     T)  A  I  R  V  I  N  {)  495 

of  education  to  the  people  at  large  as  to  where  their  interests 
lie  in  this  milk  question. 

I  want  to  ask  you  frankly  just  one  question  here:  — 
Supposing  that  it  should  come  to  pass  that  we  should 
find  an  increase  of  70  per  cent  for  milk  products  —  as  they 
found  a  70  per  cent  increase  in  the  demand  for  oranges 
under  a  similar  campaign  —  who  is  going  to  furnish  the 
milk  products?  That  is  the  difficulty  which  we  are  up 
against.  Who  is  going  to  furnish  this  material?  Just  at 
this  time  this  year,  we  have  a  little  surplus  of  milk  that  is 
due  to  local  conditions.  The  tariff  has  knocked  out  the 
condensed  milk  business  almost  entirely.  That  has  got 
to  be  fixed  some  way.  In  the  second  place  the  season  has 
been  one  in  which  the  ice  cream  business  has  gone  to  pieces. 
The  ice  cream  has  not  amounted  to  anything,  and  conse- 
quently for  all  that  mass  of  milk  which  has  been  used  as  a 
foundation  to  ice  cream,  all  of  that  demand  has  been  prac- 
tically cut  off.  In  the  third  place,  we  have  such  a  flush  of 
pasture  that  we  have  had  a  larger  supply  of  miUc  than  usual. 
The  result  is  that  we  have  more  milk  than  we  need.  That 
is  just  temporary,  it  is  not  going  to  last. 

The  fact  is  that  we  have  not  nearly  enough  miUc  to  sup- 
ply our  legitimate  demand  when  we  make  that  demand. 
The  intelligent  demand  for  dairy  products  should  not  come 
before  the  milk  supply  of  this  country  will  be  equal  to  what 
it  ought  to  be.  It  is  the  work  of  the  people  to  see  that  the 
supply  goes  right  along  increasing,  and  that  our  agricul- 
tural districts  have  their  original  fertility.  We  could  not 
supply  the  milk  to-day  if  that  demand  were  on  us. 

There  is  n't  any  where  near  the  milk  produced  to  sup- 
ply the  demand  that  there  is  going  to  be.  What  are  we 
going  to  do?  We  are  going  to  increase  the  dairy  business 
and  we  are  going  to  increase  the  economy  of  the  operation 
of  dairy  business.  We  are  going  to  see  that  the  cows  be- 
come economical  and  profitable  cows.  But,  how  many 
cows  do  3"Ou  think  there  are  in  the  United  States  that  are 


496  HENRY     BAIRDFAVILL 

not  economically  justified?  The  estimates  are  from  25  to 
40  per  cent,  but  there  is  no  question  that  there  are  multi- 
tudes of  cows  milked  twice  a  day,  eating  feed  that  they  are 
not  paying  for,  according  to  the  milk  they  produce.  What 
are  we  going  to  do  about  it?  We  talk  about  our  cow  test- 
ing associations  measuring  our  product  by  the  pound,  our 
scrupulous  care  in  w^eeding  out  the  poorer  cows,  because  they 
are  not  profitable,  and  so  forth.  It  is  hard  to  say  what  the 
result  would  be  towards  the  general  milk  situation  and  it  is 
very  hard  to  say  that  we  can  afford  to  kill  off  wholesale 
all  those  cows  that  are  close  to  the  margin  of  profit.  I  sup- 
pose that  there  are  cows  that  are  bad  enough  to  be  killed, 
but  there  are  many  cows  that  milk  close  enough  so  that  we 
can't  afford  to  spare  them.  What  good  are  they,  if  we 
increase  that  kind  of  cows?     There  is  the  whole  point. 

If  it  be  true  that  a  mediocre  cow,  an  unprofitable  cow, 
can  not  produce  with  the  right  management  a  calf  that  will 
grow  up  into  a  better  cow,  then  there  is  no  use  in  permitting 
the  life  of  such  a  cow  to  continue.  But,  you  know  that 
is  not  true.  Crossing  good  bulls  on  inferior  cows  has  built 
up  good  herds.  It  is  the  very  essence  of  this  question  that 
I  am  now  propounding  for  our  milk  supply. 

Bear  in  mind  that  we  are  not  going  to  deal  with  the 
question  of  our  increased  milk  supply  from  the  standpoint 
of  big  herds  with  sixty  or  seventy  cows.  We  are  going  to 
deal  with  it  from  the  standpoint  of  the  farmer  with  from 
three  to  fifteen  cows.  That  is  how  we  are  going  to  deal 
with  it.  Bear  in  mind  that  I  am  not  going  to  defend  the 
border  cow,  but,  if  she  is  reasonably  hopeful  we  do  not 
want  to  kill  her,  because  it  is  possible  for  the  next  genera- 
tion to  be  better,  and  we  want  the  next  generation  to  be 
brought  upon  a  better  basis. 

It  comes  down  to  the  question  of  what  the  average 
farmer  is  going  to  do  about  it.  "What  is  the  use  of  my 
having  a  good  bull?  Anything  will  do."  That  is  a  hope- 
less situation,  and  the  sooner  he  is  brought  out  of  it,  the 


A  (;  K  I  {•  U  I.  Til  RE     ANT)     DAIRYING  497 

better  for  liimsclf  ;md  everybody  concerned.  But  if  he 
says  "no"  and  has  a  fixed  plan  in  buying  a  bull  that  is  gr>od 
enouK'h,  he  should  avoid  the  mistake  of  buying  too  good  a 
bull  which  may  ha[)i)cn  if  he  forgets  his  cows.  He  wants 
a  good  herd,  but  it  can't  be  done  without  an  intelligent 
introduction  of  promising  blood  into  that  herd.  The  hard- 
est problem  before  us  to-day  is  to  persuade  the  ordinary 
farmer  with  inferior  cows  that  it  will  pay  him  to  get  a  bull 
that  is  good  enough  to  go  into  his  herd.     You  know  that. 

Don't  you  see  that  with  our  campaign  of  education  for 
a  larger  demand  for  milk  products  should  go  an  educational 
campaign  for  a  larger  production,  because,  if  we  get  a  de- 
mand twice  as  large  as  now,  and  the  production  is  not  in- 
creased accordingly,  the  price  of  the  product  will  soar,  and 
when  the  price  goes  beyond  a  certain  amount,  it  tends  to 
cut  off  the  use  of  the  product?  Forty  cents  a  pound  for 
creamery  butter  is  a  bad  thing  for  the  dairy  business  rather 
than  a  good  thing.  You  know  that  there  is  a  certain  price 
at  which  the  public  will  buy,  and  up  to  that  price  it  is  a  good 
thing  for  the  farmer,  but  the  minute  the  price  goes  beyond 
that  price,  the  consumption  of  the  product  begins  to  fall 
away  and  it  is  a  bad  thing  for  the  farmer.  If  it  goes  be^^'ond 
the  point  where  the  supply  is  adequate  for  the  demand,  so 
that  the  price  goes  up,  consumption  falls  away  and  your 
last  condition  as  a  dairyman  is  worse  than  the  first  condition. 
So,  unless  your  campaign  for  better  herds,  better  cows, 
and  better  breeding  goes  hand  in  hand  with  the  campaign 
for  a  larger  use  of  milk  products,  your  last  condition  is  go- 
ing to  be  worse  than  your  first.     Don't  fail  to  see  that. 

That  brings  us  to  the  question,  what  are  we  going  to  do 
with  the  ordinary  farmer  that  does  not  see  the  point  about 
having  a  good  bull?  I  said  a  minute  ago  that  it  was  just 
as  bad  a  mistake  to  get  too  good  a  bull  as  to  get  too  poor  a 
one.  I  meant  that.  I  want  to  bring  3^ou,  if  I  can,  into  my 
frame  of  mind  on  this  question  of  breeding  dain,'  cows.  I 
take  your  time  to  do  it,  because  I  don't  think  all  people 


498  HENRY     BAIRD     FAVILL 

see  it  as  I  do.  I  have  talked  about  it  to  old  breeders  and 
very  intelligent  men  who  don't  see  it. 

It  is  this, — the  purebred  business  has  no  justification 
under  the  sun  except  for  the  influence  it  can  have  upon 
the  grade  business.  Now  think  about  that  for  a  few 
minutes.  The  gradesmen  look  at  the  purebred  men,  at 
the  great  prices,  at  the  great  sales,  and  the  whole  make-up 
is  to  them  spectacular.  They  say,  "That  is  all  right  for 
the  purebred  men,  but  it  does  not  interest  us."  Until 
every  grade  man  can  come  to  see  that  the  purebred  busi- 
ness is  in  existence  for  his  benefit  and  for  no  other  purpose 
on  earth,  he  is  not  in  the  right  frame  of  mind.  There  is 
not  any  justification  for  the  purebred  business  except  to 
breed  bulls  that  can  go  on  in  the  grade  herds  and  make 
them  better,  and  if  they  don't  do  that,  they  are  absolutely 
failing  in  their  mission  and  have  not  touched  the  purpose 
of  their  existence.     Let  us  think  of  this  for  a  while. 

The  purebred  men  do  not  see  that.  They  buy  and  sell 
among  themselves,  they  get  a  great  big  price  and  the  cows 
make  big  records.  When  they  are  dealing  among  them- 
selves they  do  not  think  what  their  ultimate  purpose  in 
life  is. 

It  goes  without  saying  that  a  great,  big,  high-priced 
bull  ought  not  to  go  in  a  grade  herd  unless  the  herd  is  worth 
it.  I  am  not  stopping  to  discuss  the  value  of  bulls,  I  am 
not  stopping  to  discuss  what  their  bulls  are  worth  because 
it  is  quite  likely  that  from  some  points  of  view,  the  bull  is 
worth  a  great  deal  of  money.  Bear  in  mind  that  a  pure- 
bred business  is  a  pedigree  business.  I  don't  know  just 
how  valuable  any  given  animal  might  be  in  a  given  herd. 
A  given  bull  may  be  worth  a  great  deal  of  money.  I  am 
not  concerned  with  that. 

If  a  bull  is  too  high-priced  and  really  too  good  from  a 
certain  standpoint  for  a  certain  herd,  that  does  n't  mean 
that  his  son  is  too  good  or  his  grandson  is.  There  is  going 
to  be  a  good  bull  somewhere  that  is  going  to   bring   the 


A(;RI  CULTURE     AND     DAIRYING  49Q 

herd  out  of  its  mediocre  rut  (ind  will  not  be  too  expensive 
to  use. 

Distribute  good  bulls  on  the  eommon  herds  in  the 
country.  It  is  a  pretty  difficult  thing  for  people  to  do  that 
in  the  purebred  business.  It  is  not  an  easy  thing  for  me  to 
make  a  campaign  for  good  bulls  and  get  them  distributed 
over  the  grade  herds  of  the  country  by  persuading  grade 
men  that  I  am  solely  interested  in  them  as  breeders  of 
better  cattle.  A  grade  man  will  say,  "If  he  is  interested 
in  me,  why  doesn't  he  give  me  a  bull?"  I  did  do  that 
last  year.  Last  year  was  a  bad  one  for  us  in  the  bull  busi- 
ness. Up  at  Lake  Mills,  Wisconsin,  where  my  breeding 
goes  on,  it  is  a  great  Holstein  country.  All  my  bulls  are 
worked  off  by  people  passing  through  that  section  of  the 
country.  They  are  worth  from  $150  to  $200  and  they 
go  off  to  grade  herds.  Last  year  I  must  have  had  twelve 
yearlings  left,  and  I  never  had  a  yearling  on  the  place  be- 
fore. I  did  n't  know  what  to  do  with  them.  Well,  I  have 
a  cousin  who  is  interested  in  grades.  I  wanted  to  send 
these  yearlings  on  to  Chicago.  He  wanted  to  ship  them 
to  Chicago  for  beef.  I  would  n't  do  that.  I  thought  the 
matter  over.  Finally  I  decided  to  distribute  them  on  the 
grade  herds,  and  then,  after  they  had  done  all  the  good 
they  could,  my  cousin  could  beef  them  and  take  what  there 
was  in  them.  If  we  can't  sell  our  bulls,  we  ought  to  give 
them  away.  It  is  better  for  me  to  give  my  bulls  to  my 
neighbor  than  to  have  him  drag  along  and  not  improve 
his  cattle. 

But  after  all,  all  joking  aside,  don't  you  see  that  the 
real  gist  of  the  matter  is  right  there ;  that  we  must  improve 
the  herds  of  cattle  in  order  to  be  able  to  meet  the  increased 
demand,  if  we  are  going  to  whip  up  this  demand?  It  is 
the  small  herd  that  is  in  question.  We  can  improve  those 
only  by  good  bulls.  Who  is  going  to  distribute  them? 
It  seems  to  me  that  the  only  possible  way  in  which  this  is 
going  to  be  solved  is  by  having  some  disinterested  party, 


Soo  HENRY     B  A  I  R  D     F  A  V  I  L  L 

like  the  Count}^  Agent  or  some  other  agency  who  will  make 
a  census  of  the  bulls  that  are  available,  list  what  they  are 
really  worth  and  in  some  way  or  other  create  a  market 
that  is  good  enough.  Find  some  kind  of  place  where  a 
farmer  can  get  a  bull  good  enough  for  his  purpose  and  at  a 
reasonable  price,  and  some  place  in  which  he  will  have 
confidence. 

One  of  the  greatest  questions  before  us  to-day  is  how  to 
establish  a  machinery  for  the  distribution  of  the  purebred 
bulls  on  the  grade  herds  in  this  country.  There  is  one 
difficult  part  of  this  situation.  It  is  almost  impossible  to 
tell  how  good  a  given  individual  may  prove  to  be.  There 
is  a  certain  gamble  in  this,  and  nothing  can  solve  it  in  ad- 
vance. The  only  thing  to  do  is  to  consider  your  founda- 
tion, 3^our  breed,  the  bull's  ancestor  and  in  general  take 
chances.  That  is  the  one  point  that  we  must  face.  It  is 
almost  impossible  to  tell  what  any  particular  animal  is 
going  to  do  if  he  is  going  to  be  a  success.  But  aside 
from  that  gamble,  aside  from  getting  a  bad  bull  as  far  as 
conformation  is  concerned,  there  is  no  risk  whatever  in 
some  disinterested  agency  distributing  to  the  farmers  bulls 
that  are  good  enough  to  insure  progress  on  to  a  better  and 
to  a  larger  prosperity. 

Now  to  sum  up  all  the  points:  In  the  first  place,  the 
need  of  our  agriculture,  then  the  absolute  dependency  of 
our  agriculture  upon  dairying;  the  need  of  our  influencing 
people,  so  far  as  their  health  is  concerned,  on  dairying; 
the  absolute  need  for  giving  them  the  important  informa- 
tion as  to  the  value  of  dairy  products  to  create  a  demand, 
and  then,  the  absolute  necessity  of  having  a  supply  for 
that  demand;  and  finally,  the  fundamental  problem  of 
increasing  and  improving  the  average  cow  production  of 
this  country  so  that  it  shall  not  only  be  economical  in  per- 
formance and  adequate  to  meet  the  demand,  but  that  it 
shall  be  an  upward  step  in  the  general  upward  progress  of 
the  dairy  cow  which  shall  know  no  limit. 


A  c;  R  I  (•  IJ  I.T  (J  RE     AND     I)  A  I  K  Y  I  N  (i  SOi 


Delivered,  I^'irsl  Aiiimnl   Mccliiif;;  of  Ihe  National   Dairy  Council,  Chi- 
cago,  November  5,    I'ji.S- 
Printed  specially. 

THE   CALL   TO   ARMS 

IN  setting  forth  the  reason  for  the  eall  of  this  unusual 
gathering  of  men,  it  is  well  to  regard  briefly  the  his- 
tory of  the  National  Dairy  Council,  the  body  which 
has  assumed  responsibility  for  this  gathering. 

During  the  National  Dairy  Show  of  19 13  there  was  a 
gathering  of  men  representing  all  the  prominent  branches 
of  the  dairy  industry,  the  majority  of  whom  were  delegates 
selected  by  the  representative  organizations.  At  this  meet- 
ing, after  full  discussion,  there  was  created  a  National 
Dairy  Council,  which  at  that  point  was  regarded  as  a  circle 
within  the  National  Show. 

As  then  conceived,  its  purposes  were  vaguely  defined. 
The  general  idea  underlying  its  formation  was  to  promote 
more  intimate  acquaintance  and  opportunity  for  freer  dis- 
cussion and  promotion  of  the  interests  which  are  found  to 
be  common  within  the  industry. 

As  time  went  on  the  various  inter-relations  became 
better  defined,  and  it  was  found  that  there  are  many  ques- 
tions and  problems  facing  the  dairy  industry  which  point 
logically  to  better  organization  and  closer  coherence  of  all 
factors  in  this  enormous  field.  Whereas  at  the  outset  the 
predominating  idea  was  internal  harmony  and  furtherance 
of  a  forum  which  could  be  regarded  in  the  light  of  a  clearing 
house  for  all  subjects  germane  to  the  industry,  but  more 
particularly  within  it,  it  developed  clearly  that  there  is  still 
greater  need  for  such  organization  as  will  enable  the  indus- 
try to  fortify  itself  in  its  general  commercial  relations. 

Many  matters  of  serious  import  became  distinctly  issues 
for  consideration,  and  culmination  occurred  at  the  time  of 
the  1 9 14  Dairy  Show,  when  the  appalling  menace  of  the 


S02  HENRY     B  A  I  R  D     F  A  V  I  L  L 

foot-and-mouth  disease,  with  its  ensuing  campaign  of 
eradication,  including  quarantine  of  the  cattle  at  the  Dairy 
Show  and  all  the  problems  legitimately  arising  therefrom, 
precipitated  upon  the  consciousness  of  all  people  related 
to  the  industry,  a  conviction  that  dairying  as  a  factor 
in  national  prosperity  is  dangerously  unprepared  to  cope 
with  the  natural  vicissitudes  and  perils  which  can  arise 
to  threaten  an  industry  so  fundamental,  so  colossal,  and  so 
unorganized. 

Accordingly  in  the  spring  of  1915,  the  National  Dairy 
Council  was  reorganized,  separated  in  form  from  the  Nation- 
al Dairy  Show  and  established  upon  a  basis  of  activity 
which  contemplates  incorporation  into  one  body,  so  far  as 
circumstances  may  demand,  of  all  interests  which  are 
solely  or  largely  dependent  upon  the  dairy  cow. 

It  is  the  aim  of  the  Council  to  bring  into  its  organiza- 
tion to  the  largest  possible  extent  the  men  who  produce  the 
milk,  who  manufacture  milk  products,  who  provide  ma- 
terials, machinery,  and  transportation,  who  provide  a 
market  and  facilities  for  distribution,  and  finally  the  officials, 
administrative  or  educational,  whose  counsel  and  official 
functions  bear  so  vital  a  relationship  to  the  ultimate  esti- 
mate and  value  of  dairy  products  furnished  for  public 
benefit. 

To  this  end  an  effort  is  made  to  enlist  farmers  and 
educators,  distributors,  machinery  men,  manufacturers  of 
butter,  cheese,  machinery,  feed,  cement,  milk  dealers,  and 
health  officials.  It  is  hoped  that  coordination  may  be 
effected  with  the  state  agricultural  stations,  the  National 
Department  of  Agriculture,  and  so  on  through  all  the  list 
of  cognate  branches  of  public  service,  with  full  realization 
that  in  the  last  analysis  there  is  no  conflict  of  interests ;  on 
the  contrary,  such  community  of  interest  as  must  be  recog- 
nized and  conserved  in  order  full^^  to  advance  an  enterprise 
upon  which  more  than  upon  any  other  foundation  rests 
national  prosperity. 


A  (;  K  I  (•  n  r.  TURK    and    dairying  503 

The  Dairy  C'ouncil  rccoj^nizcs  that  the  essence  of  its  cam- 
paign must  be  education.  On  the  one  hand,  education  of 
the  people  whose  business  interest  is  immediately  involved : 

1.  As  to  the  importance  of  their  product. 

2.  As  to  the  inherent  weakness  of  their  commercial 
status. 

3.  As  to  the  ])rogrcss  of  time  whicli  demands  eradica- 
tion of  essential  defects  in  methods,  quality,  and  value. 

On  the  other  hand,  education  of  the  public  as  to  the 
true  estimate  which  should  be  placed  upon  milk  and  its 
products  in  the  domestic  economy  of  the  country;  and 
finally  dissemination  through  all  available  channels  of  the 
idea  that  the  future  of  American  agriculture  is  indissolubly 
bound  to  animal  husbandry,  and,  as  the  matter  unfolds, 
more  than  upon  any  other  branch  of  animal  husbandry 
does  it  depend  upon  the  progress,  development,  and  value 
of  the  dairymen. 

At  the  very  foundation  of  this  structure  stands  the  man 
who  produces  milk  upon  which  the  entire  industry  depends. 
His  position  is  one  of  peculiar  precariousness.  On  the  one 
hand,  his  product  is  more  perishable  than  any  other.  He 
is  consequently  under  the  necessity  of  finding  an  immediate 
market,  and  is  hence  open  to  the  influence  of  accidental  or 
intentional  circumstances  that  leave  him  peculiarly  defense- 
less. On  the  other  hand  his  product  is  subject  to  such 
change  in  quality  as  to  make  it  of  the  utmost  importance 
that  the  condition  in  which  it  is  presented  to  the  public 
for  consumption  shall  be  scrutinized  and  as  far  as  possible 
standardized  in  order  to  conform  to  modern  conception  of 
public  welfare. 

In  this  serious  situation  it  is  imperative  that  measures 
looking  to  the  ultimate  development  of  the  industry-  be  so 
widely  and  comprehensively  conceived  that  the  problem 
involving  the  milk  producer  shall  be  regarded  not  at  all  as 
his  problem,  but  a  matter  in  which  the  whole  nation  is 
directly  and  indirectly  involved. 


S04  HENRY     BAIRD     FAVILL 

Unjust  or  unintelligent  warfare  upon  the  milk  pro- 
ducer imperils  not  only  the  interests  directly  involved  in 
the  industry,  but  still  more  vitally  the  interests  of  every 
individual  dependent  for  his  daily  food  upon  milk  or  its 
products. 

The  National  Dairy  Council  aims  to  bring  into  this 
grave  situation  deeper  understanding,  more  harmonious 
action,  and  more  profound  realization  of  the  fundamental 
importance  of  the  entire  subject.  Amongst  the  problems 
which  present  themselves  for  immediate  attention  it  has 
chosen  to  regard  as  most  important  the  widespread  ignor- 
ance on  the  part  of  the  public  as  to  the  essential  value  of 
milk. 

When  one  considers  the  fact  that  it  would  be  practically 
impossible  to  rear  the  young  of  the  nation  without  milk; 
that  some  form  of  proteid  food  is  absolutely  essential  to  the 
growth  and  maturing  of  young  animals,  and  most  important 
of  these,  children;  that  milk  is  the  cheapest  form  of  animal 
proteid  food  that  is  to  be  had;  that  it  is  the  only  animal 
proteid  which  contains  all  the  elements  necessary  to  growth 
and  development;  that  its  various  products  in  its  more 
permanent  form  as  butter,  cheese,  condensed  milk,  ice 
cream,  and  milk  powder  are  cheaper  and  better  food  than 
any  other  available  —  it  is  high  time  that  the  public  should 
be  brought  to  a  realization  that  milk  is  not  a  luxury,  but  a 
necessity;  that  it  is  not  expensive,  but  relatively  cheap; 
and  consequently  that,  by  thorough  organization  of  the 
point  of  view  of  the  public,  an  enormously  greater  and  more 
stable  market  can  be  created  which  will  stimulate  and 
encourage  larger  production  and  higher  quality  at  every 
point. 

It  is  common  knowledge  that  there  has  been  in  this 
country  this  year  a  surplus  of  milk.  Are  you  disposed  to 
question  why  try  to  increase  the  supply?  Let  me  answer 
by  another  question.  Does  any  thinking  man  believe  that 
there  is  more  milk  than  the  country  needs?     The  answer 


AGRICULTURE     AND     DAIRYING  505 

is  ohvioiis.  The  (•()iintry  has  noL  been  supplied  with  one 
quarter  its  needs  from  the  standpoint  of  its  physical  and 
financial  welfare.  But  there  is  another  profound  considera- 
tion—we have  spoken  of  animal  husbandry  as  the  founda- 
tion of  national  prosperity  through  its  agriculture.  What 
does  this  mean? 

It  means  that  the  worn-out  farms  of  New  England,  of 
the  South,  and  fast  declining  fertility  of  the  great  West,  the 
highly  specialized  agriculture  of  the  fruit  country,  and  even 
the  wonderfully  fertile  farms  of  the  Mississippi  Valley  are 
crying  for  cattle. 

There  is  no  way  known  to  man  whereby  fertility  of  soil 
can  be  conserved  and  increased  except  through  the  agency 
of  animal  manure.  Only  by  this  means  can  the  enormous 
yield  upon  the  earth's  surface  of  food  material  which  is  not 
fitted  for  human  food  be  transformed  and  redeposited  in  the 
land  in  order  to  make  the  land  yield  more  human  food. 

Every  student  of  agriculture  is  agreed  upon  this  propo- 
sition. But  why  dairy  cattle  rather  than  beef  cattle?  As 
things  have  developed,  beef  can  not  be  fed  except  upon  a 
very  close  margin  of  profit.  Experience  shows  that  it  is 
dairy  cattle  that  build  up  prosperity  of  any  country. 

There  are  in  this  country  6,000,000  farms.  Every  one 
of  them,  be  it  corn,  wheat,  apple,  lemon,  cotton,  or  other 
product,  that  is  not  thoroughly  stocked  is  running  down  in 
fertility. 

There  are  in  this  country,  roughly  speaking,  22,000,000 
dairy  cattle,  on  the  average,  three  or  four  animals  to 
a  farm.  A  mature  cow  produces  67  pounds  of  manure  daily, 
about  a  ton  a  month,  but  on  the  average  less  than  ten  tons  a 
year  —  sufficient  to  moderately  fertilize  one  acre.  Such 
fertilization  should  occur  at  least  every  there  years.  Three 
cows  per  farm  are  hence  able  to  protect  the  fertility,  at  the 
outside,  of  nine  acres. 

Does  it  take  an}-  argument  to  show  that  the  countr}^ 
can  not  proceed  upon  this  basis?     There  must  be  either  an 


5o6  HENRY     BAIRD     FAVILL 

improvement  in  this  situation  or  deterioration  in  national 
wealth. 

Let  no  man  underestimate  this  problem.  It  is  the 
greatest  problem  before  the  country  to-day.  It  is  beyond 
all  other  questions  the  one  where  preparedness  is  the  vital 
issue.  Although  this  is  in  general  a  matter  of  interest  to 
every  citizen,  as  a  specific  problem  it  falls  to  the  people 
immediately  interested  to  solve  it.  The  danger  is  that  the 
vast  business  interests  related  hereto  and  dependent  on  the 
dairy  industry  will  not  see  their  obligation.  I  put  this 
not  upon  altruistic  grounds  —  I  put  it  upon  enlightened 
self-interest. 

Hitherto  the  commercial  army,  dependent  upon  the 
dairyman,  has  addressed  itself  to  increasing  the  dairy 
product  and  in  consequence  increasing  its  own  sale  of 
materials  to  the  dairyman.  Never  have  they  with  any 
serious  or  comprehensive  effort  addressed  themselves  to 
providing  for  the  dairymen  a  market  sufficiently  adequate 
to  encourage  them  to  larger  production,  larger  number  of 
stock,  and  better  quality.  These  movements  have  come 
from  the  dairymen  themselves. 

It  is  incumbent  upon  the  manufacturing  and  distribut- 
ing interests  to  see  to  it  that  there  is  such  appreciation  of 
the  value  and  need  of  dairy  products  throughout  the  con- 
suming public  as  shall  enable  the  farmers  of  this  country  to 
protect  themselves  by  carrying  more  live  stock,  and  in 
this  way  —  and  this  way  only  —  protect  the  country  against 
impoverishment. 

Let  every  man,  no  matter  which  his  branch  of  industry, 
realize  his  personal  relation  to  this  need.  There  is  no  in- 
dustry here  represented  so  remotely  and  indirectly  related 
to  this  matter  that  it  will  not  profit  by  a  wise  campaign. 
It  is  true  that  the  campaign  will  cost  money  —  a  great  deal 
of  money.  It  is  true  that  those  who  do  not  contribute 
money  will  profit  equally  with  those  who  do  contribute; 
but  the  time  has  come  when  men  shall  act  in  this  matter 


A  (i  R  I  (■  n  F, 'I"  i:  K  r:    and    f)A  ikying  507 

ethically,  which  means  cooperatively  and  with  a  jjurpose 
fairly  to  sliarc  the  l)iii-(1cns  involved. 

It  takes  no  extraordinary  intelligence  to  recognize  that 
the  returns  in  actual  profit  will  be  multi])lied  many  fold,  no 
matter  what  the  initial  (•r)st. 

In  consequence  of  this  reasoning  the  Dairy  Council  has 
decided  to  lay  before  you  representatives  of  all  phases  of 
this  vast  industry  a  plan  to  promote  the  use  of  dairy  prod- 
ucts through  a  campaign  of  publicity,  which  shall  be 
countrywide,  thorough,  and  intensive.  It  has  invoked  the 
aid  for  purposes  of  presentation  of  some  of  the  great  ad- 
vertising agencies  of  the  country,  and  is  prepared  to  lay 
before  you  a  suggestion  for  your  approval,  and  action  if 
approved,  which  shall  carry  this  work  on  through  a  period 
of  time,  probably  for  years,  in  the  effort  to  create  public 
opinion  and  public  appreciation  which  shall  place  the  dairy 
industry,  and  through  that  agricultural  welfare,  upon  a 
solid  foundation. 

At  the  outset,  while  the  necessity  for  frequent  meetings 
in  the  process  of  organization  was  prominent,  the  directory 
of  the  Dairy  Council  was  made  up  of  delegates  selected  by 
the  various  branches  of  the  industry  whose  residence  and 
business  possibilities  permitted  close  attention  to  the  work. 

It  is  desirable  beyond  question  that  a  sufficient  number 
of  members  of  any  committee  that  is  appointed  to  further 
this  campaign  of  advertising  be  so  located  as  to  be  practi- 
cable from  this  point  of  view. 

On  the  other  hand,  it  is  highly  desirable  that  all  parts 
of  the  country  be  not  only  represented,  but  shall  be  con- 
vinced that  they  are  represented,  and  by  whatever  method 
this  body  shall  proceed,  that  these  factors  be  kept  in  mind. 

The  Dairy  Council  presents  to  you  this  project  and  asks 
of  you  your  earnest  consideration. 


So8  HENRY     BAIRD     FAVILL 


Printed,  Hoard's  Dairyman,  December,  191 5. 

WHAT  SHOULD  BE  DONE  TO  PROTECT  OUR 
LIVESTOCK  ? 

IT  is  wholesome  and  timely,  now  that  the  atmosphere 
has  sufficiently  cleared,  and  there  is  reasonable  as- 
surance that  a  great  national  disaster  has  been  averted, 
to  reflect  seriously  and  with  determination  upon  the  coun- 
try's experience  each  according  to  his  lights  and  each  with 
the  purpose  of  contributing  whatever  he  may  to  the  general 
maintenance  and  progress  of  the  livestock  interests  of  the 
country. 

Although  the  immediate  dangers  are  by  no  means  re- 
moved, it  is  reasonable  to  believe  that  the  epidemic  of 
foot-and-mouth  disease  is  and  will  continue  to  be  under 
control. 

The  occurrences  of  the  last  twelve  months  have  brought 
into  focus,  as  never  before,  definite  problems  related  to 
animal  husbandry.  It  is  agreed  through  all  classes  of 
citizens  of  the  United  States  that  the  basis  of  our  national 
prosperity  is  agriculture.  With  a  sweeping  and  admiring 
glance  at  our  unlimited  resources,  we  are  disposed  to  repose 
comfortably  in  the  assumption  that  we  never  can  starve. 

The  few  acute  analytical  students  of  the  subject  who 
are  patiently  and  persistently  pointing  out  the  trend  of 
our  affairs,  have  on  the  whole  a  small  audience.  The 
country  by  and  large  is  disposed  to  plume  itself  upon  its 
agricultural  resources. 

There  is  a  large  foundation  of  truth  under  this  com- 
placency. As  a  matter  of  political  economy  however,  it 
has  neither  dignity  nor  value.  Most  of  the  confident 
assumption  in  the  premises  is  mere  platitude.  Only  in  so 
far  as  national  policy,  reflected  more  or  less  accurately  in 
the  utmost  ramifications  of  individual  industry,  recognizes 
and  expounds  the  intricate  interrelations  of  agriculture  and 


A  r,  RIC  TJT.  TU  RK      AND     DAIRYING  509 

commercial  interests  can  it  be  said  that  the  future  ])T0- 
ductivcness  of  this  country  is  assured. 

It  is  easy  for  men  to  magnify  the  importance  of  phases 
of  the  subject  to  wliidi  they  are  immediately  related.  If 
experience  has  any  value  it  should  teach  that  the  factor  of 
ineffectiveness  in  the  progress  of  agriculture  has  been  lack 
of  comprehensiveness  of  view  and  plan. 

It  is  with  full  consciousness  therefore  of  the  danger  of 
narrowness  of  view  that  I  approach  this  question,  of  safe- 
guarding the  livestock  interests  of  the  nation. 

However  great  may  be  the  importance  of  other  factors 
in  the  complex  of  our  national  food  industry,  it  is  beyond 
question  that  the  livestock  factor  is  paramount.  Waiving 
for  the  moment  entirely,  the  question  of  their  specific  pro- 
duction, labor  or  other  contributing  factors,  farm  animals 
furnish  the  sole  practical  means  of  conserving  that  part  of 
the  earth's  product  not  available  for  human  sustenance  and 
retiirning  this  major  part  of  the  product  to  be  devoted  again 
to  the  beneficial  use  of  man  through  fertilization  of  the  land. 

This  simplest  of  truisms  to  the  agricultural  student  is 
not  common  information.  Because  it  is  not,  the  public, 
upon  whose  backing  every  democracy  rests,  is  not  the  source 
of  strength  and  safety  which  its  vital  interest  in  the  matter 
would  suggest. 

It  remains  therefore  for  our  educating  forces,  and,  chief 
amongst  these,  government  agencies,  to  mold  the  public  mind 
to  follow  and  endorse  its  investigations  and  conclusions. 

It  seems  to  me  then,  that  the  prime  factor  of  safety  in 
furthering  the  live  stock  interests  in  the  United  States  is 
confidence  in  the  Bureau  of  Animal  Industr\\ 

The  agricultural  stations  throughout  the  country-  are  of 
course  centers  of  intense  thought  and  industry;  with  vary- 
ing degrees  of  success  they  are  striving  to  solve  the  problems 
of  agriculture.  The  government  should  be  the  distributor 
of  reliable  conclusions  from  these  sources  and  all  others. 
It  ought  to  be  true  that  an  utterance  from  the  National 


5IO  HENRY     BAIRD     FA  V  ILL 

Department  of  Agriculture  should  bear  such  finality  as  the 
development  of  human  knowledge  permits. 

That  there  is  general  confidence  in  the  Department  of 
Agriculture  is  beyond  doubt  true.  That  its  contribution 
to  the  point  of  view  of  the  public  is  thus  far  inadequate  is 
equally  true.  The  educational  values  of  the  Department 
have  hardly  started  toward  full  development. 

It  is  necessar}^  to  realize  that  development  in  this  direc- 
tion involves  generous  expenditure  of  money.  Money  is 
acquired  through  Congress,  and  Congress  is  supported  by 
public  opinion.  A  point  of  view  on  the  part  of  the  public, 
intelligent  and  sympathetic  with  the  purposes  of  the  Depart- 
ment, should  be  the  foundation,  not  only  of  organized 
support  but  of  such  recast  of  official  tradition  as  would 
make  it  impossible  that  political  considerations  in  any  way 
impairing  the  service  could  be  tolerated. 

Whereas  practical  politics  will  probably  always  play  its 
part  in  appropriation  measures,  it  is  beyond  measure  im- 
portant that,  in  this  direction,  merit  and  not  pressure  from 
any  source  should  be  the  determining  factor.  Stability  of 
organization,  consistency  of  policy,  and  full  effectiveness  is 
the  demand  of  the  country  upon  its  agricultural  department. 

If  the  governments  had  been  adequately  financed  and 
their  policies  beyond  question  supported  by  the  public, 
there  would  never  have  been  material  difficulty  in  carrying 
out  measures  of  eradication  of  the  foot-and-mouth  disease 
which  State  and  government  officials  have  conducted  under 
such  enormous  difficulties. 

The  crux  of  that  whole  matter  was,  and  is,  and  always 
will  be,  just  compensation  to  the  owners  of  stock  whose 
property  is  destroyed  for  the  public  benefit.  Enlightened 
public  opinion  and  adequate  compensation  would  have 
reduced  opposition  to  a  minimum. 

The  second  factor,  therefore,  of  importance  to  livestock 
protection,  is  money.  Under  present  conditions,  however, 
even  if  the  foregoing  two  factors  had  been  satisfactory,  there 


A  (;  K  1  C  U  L  T  U  R  K     AND     J)  A  I  R  V  I  N  C;  511 

is  an  essential  weak  spot  in  animal  husbandry  economics. 
Effective  administration  of  matters  pertaining  to  health 
and  proper  function  of  livestock  involves  the  highest  grade 
of  veterinary  service.  Under  ordinary  conditions,  veter- 
inary intelligence  in  this  country  is  seriously  insufficient 
for  its  needs.  Under  extraordinary  conditions  this  lack 
becomes  a  serious  peril.  Tlic  United  vStates,  by  and  large, 
is  not  performing  its  duty  in  the  matter  of  veterinary  edu- 
cation. Nobody  claims  that  it  is.  Competent  veterinaries 
could  be  multiplied  many  fold  to  the  great  advantage  of 
stock  raising.  I  refer  now  not  only  to  veterinary  treatment 
but  far  more  emj^hatically  to  educational  work  in  the  direc- 
tion of  preventive  measures  which  with  propriety  should 
be  regarded  as  the  highest  function  of  veterinary  service. 
The  third  factor  which  I  advance,  therefore,  is  men. 

With  this  foundation  the  country  would  be  equipped  to 
render  service  to  livestock  interests  the  best  possible  under 
present  conditions  of  knowledge.  No  tremendous  effort  to 
secure  cooperation  on  the  part  of  individual  stock  owners 
is  necessary  if  the  government  be  in  position  fully  to  meet 
its  opportunity  and  disposed  to  do  it. 

The  foregoing  discussion  relates  essentially  to  the  pres- 
ent status  and  to  conditions  which  must  be  regarded  as 
primarily  an  emergency.  Assuming  that  under  these  exi- 
gent conditions  it  shall  have  been  possible  to  clear  the 
country  of  this  scourge,  there  is  a  further  consideration  of 
the  most  vital  importance. 

No  intelligent  observer  doubts  that  the  future  of  animal 
husbandry  is  utterly  dependent  upon  wise  and  consistent 
plans  of  breeding.  The  breeding  of  purebred  cattle  bears 
the  same  relation  to  animal  husbandry  that  the  breeding 
of  pedigreed  seed  bears  to  general  agriculture,  with  this 
important  dift'erence;  that  the  time,  money,  and  efforts 
required  to  re-establish  a  product,  which  through  am* 
agency  may  have  been  destroyed,  is  many  times  greater  in 
the  case  of  animals. 


512  HENRY     BAIRD     FAVILL 

A  plan  must  be  devised,  and  as  to  the  detail  of  such  a 
plan  I  make  no  suggestion,  whereby  the  purebred  industry- 
can  be  distinguished  with  reference  to  destruction  under 
emergency,  as  a  matter  of  special  import.  Whereas  the 
owner  of  such  valuable  cattle  can  be  adequately  paid  and 
thereby  reasonably  justly  dealt  with,  the  nation  is  dis- 
tinctly and  seriously  the  loser. 

Adequate  compensation  can  remove  the  obstacle  to 
emergency  necessities.  It  can  never  protect  the  livestock 
industry  from  the  loss  of  material  and  impetus  making 
possible  better  product. 

I  realize  that  this  opens  questions  of  serious  difficulty, 
but  it  is  for  the  purpose  of  providing  the  country  with  the 
machinery  to  meet  serious  difficulty  in  questions  of  such 
paramount  importance  that  stockmen  in  the  United  States 
have  become  insistent  that  the  broadest  and  deepest  in- 
telligence available  be  directed  to  this  question.  Thus  far 
the  evidence  is  indisputable  that  official  agencies  have  not 
intelligently  estimated  this  factor. 

It  is  not  thinkable  that  the  intention  of  the  administra- 
tion is  other  than  benevolent  and  essentially  honest.  Both 
of  these  qualities  however,  require  sound  foundation.  Such 
a  foundation  can  only  be  a  product  of  deep  and  far  reaching 
wisdom  in  the  philosophy  and  practice  of  livestock  culture. 

The  organization  of  the  Board  of  Animal  Industry 
should  be  a  matter  of  deepest  concern.  The  highest  in- 
telligence of  the  country  should  be  available  either  in  ad- 
ministration or  in  effective  advisory  relation. 

To  any  extent  that  these  conditions  do  not  obtain  they 
should  be  created.  When  they  do  obtain,  public  opinion, 
effective  machinery,  and  cooperation  of  the  masses  will 
follow  logically  and  inevitably.  In  that  day  the  hundreds 
of  thousands  of  stock  owners,  upon  whose  methods  and 
efforts  the  prosperity  of  the  country  depends,  can  proceed, 
confidently  and  prosperously  in  the  working  out  of  their 
problems  presenting  so  many  intrinsic  difficulties. 


AGRICULTURE      AND     DAIRYING  <;  13 


D.'ilc  .'111(1  ()i'c;i;;i()ii  nf  vvrit.iii^.^  unknown. 

THE   EFFECT   OF   THE   WAR   ON   THE 

HOLSTEIN    BUSINESS 

AvSSEvSvSING  the  value  of  various  factors  cnU'sin^  into 
any  market  status  at  a  time  like  the  present  is  by 
110  means  a  simple  matter.  Even  though  business 
depression  distinctly  present  in  the  United  States  for  more 
than  a  year  has  touched  the  farmer  least,  and  the  dairy 
farmer  and  breeder  of  dairy  cattle  less  than  any  other,  it 
is  not  possible  to  say  that  his  actual  impairment  has  not 
been  considerable.  Granting  a  participation  in  the  general 
stagnation,  the  question  as  to  the  direct  influence  of  the 
European  War  upon  the  business  of  breeders  of  registered 
Holstein  cattle  may  be  met  with  fair  accuracy.  In  general 
the  market  for  purebred  cattle  reflects  conditions  under 
which  the  industry  at  large  is  operating.  Of  late  the  dairy 
industry  has  been  far  more  active  and  prosperous  than  the 
meat  industry.  In  consequence  the  market  for  purebreds 
has  had  a  strong  impetus.  In  particular  that  breed  will 
show  the  greatest  activity  which  is  mostly  closely  related 
to  the  commercial  dairy  industry.  Inasmuch  as  the  farmer 
is  the  producer  of  dairy  products,  the  breed  that  is  dis- 
tinctly the  farmers  breed  will  respond  most  sensitively  to 
the  conditions  pertaining  to  the  general  dairy  farmer. 

It  is  beyond  dispute  that  the  Holstein  is  at  present  the 
farmer's  cow.  Up  to  the  time  of  the  outbreak  of  the  war, 
Holstein  breeders  more  than  any  others  shared  the  pros- 
perity of  the  farmer  clientele.  To  what  extent  and  in  which 
direction  will  the  war  conditions  modify  this  aggressive 
market  ? 

It  can  scarcel}^  be  doubted  that  food  production  will 
demand  and  receive  unusual  stimulation  as  a  direct  conse- 
quence of  the  war.     Logically,  the  trend  of  production  will 
be  toward  food  that  is: 
18 


514  HENR  Y     B  AI  RD     F  A  VILL 

I.  Most  generally  used. 
•  2.  Most  indispensable. 

3.  Cheapest. 

In  all  of  these  respects  milk  is  easily  fixed.  It  is  to  be 
anticipated  that  with  every  increase  of  acuteness  in  demand 
for  food,  milk  production  will  have  the  earliest  and  most 
pronounced  stimulus. 

The  purebred  industry  is  not  a  game.  It  is  the  pro- 
duction of  pedigreed  seed.  As  such  it  is  vital  to  the  eco- 
nomic desideratum. 

Except  upon  the  principle  of  higher  yield  per  unit,  the 
dair^^  industry  can  not  stand.  Upon  breeding  of  high  pro- 
ducers depends  the  fulfillment  of  its  destiny.  So  far  as 
it  is  possible  to  foresee,  the  demand  for  registered  Holstein 
cattle  of  proven  ability  must  be  stronger  than  ever  before. 

The  index  of  activity  in  registered  cattle  as  affairs  are 
now  is  the  Public  Sale.  Most  of  the  breeds  during  the 
acute  disturbance  immediately  incident  to  the  war,  as  shown 
by  the  Fall  sales  of  19 14,  felt  a  sharp  impairment  of  market.' 
Not  so  the  Holsteins.  There  may  be  many  reasons  for  this, 
but  prominent  among  them  is  the  closeness  of  the  Holstein 
cow  to  the  general  farmer.  He  is  prosperous;  is  under 
pressure  to  produce  more ;  prefers  the  Holstein  for  his  pur- 
poses. If  there  is  doubt  as  to  the  necessity  of  increased 
activity  in  Holsteins,  it  is  not  apparent.  Demand  will 
outrun  supply. 


A  <;  K  I  C  U  LT  U  R  IC     AND     DAIRYING  5x5 


Delivered,  'I'vvenly-Sixlli  Annual  Meeting;  rndiann  State  Dairy  Associa- 
tion, Punlue  University,  LaFayette,  Ind.,  January  1.^,  KjiG. 
I'rinled,  report  of  meeting. 

THE  VALUE  OF  PUREBRED  CATTLE 

I  HARDLY  know  why  I  should  have  been  chosen  to  talk 
to  a  body  of  ]jractical  dairymen  upon  this  subject,  be- 
cause as  a  matter  of  fact  I  am  not  a  very  old  hand  in 
the  purebred  cattle  business,  although  I  have  been  in  a  way 
a  breeder  all  my  life. 

Nevertheless,  it  is  a  matter  which  is  so  important,  and 
so  near  to  my  own  heart,  that  I  am  more  than  glad  to 
be  able  to  come  before  you  and  tell  my  experiences,  if  for 
nothing  more  than  to  stimulate  your  thought,  and  if  possible 
your  questions,  and  in  general  to  mark  that  cooperative 
fellowship  that  exists  in  our  ranks. 

When  one  comes  to  weigh  the  question  of  purebred  stock 
in  general,  it  won't  do  just  to  confine  his  view  to  dairy  cattle. 
There  is  much  to  be  learned  by  observation  of  other  stock. 
I  won't  go  into  detail  very  much,  but  I  want  to  call  your 
attention,  however,  particularly  the  attention  of  the  older 
men  who  may  have  had  experience  for  a  good  many  years 
in  the  observation  of  live  stock,  to  the  conditions  in  the  beef 
industry  which  exist  to-day,  and  to  compare  them  with 
conditions  which  existed  forty,  and  thirty,  and  twenty  years 
ago.  I  am  not  speaking  about  the  market.  I  am  referring 
to  the  general  characteristics  and  class  of  cattle.  The  place 
where  one  sees  the  evidences  of  intelligent  efforts  to  breed 
beef  cattle  most  clearly  is,  of  course,  on  the  plains.  If  any 
of  you  have  been  across  the  plains  in  the  early  days,  as 
doubtless  many  of  you  have,  you  remember  the  t^'pe  of  cattle 
that  w^ere  to  be  seen.  Even  if  you  have  not  been  across  the 
plains,  3''ou  remember  the  t3-pe  of  cattle  you  have  seen  in 
the  stock  markets  and  those  brought  on  the  farms  as  stockers 
and  feeders  in  those  days.     You  realize  that  the  conditions 


5i6  HENRY     BAIRD     FAVILL 

as  they  are  to-day  on  the  plains  are  just  as  though  we  were 
deahng  with  another  class  of  animals  as  compared  to  that 
early  day.  In  those  days  there  were  unshapely,  meager, 
rough,  long-horned,  essentially  scrub  cattle,  all  over  the 
western  plains.  To-day  such  a  thing  as  a  herd  of  scrubs 
on  the  western  plains  is  almost  unknown.  You  often  see 
cattle  that  are  not  in  good  condition,  but  you  do  not  see  any 
that  do  not  bear  the  stamp  of  some  breeding. 

Now,  what  brought  this  about?  It  was  the  intelligent 
thought  of  the  big  range  men  who  were  engaged  in  that 
enterprise.  I  say  big  men,  because  any  business  that  runs 
up  into  thousands  of  head  of  cattle,  no  matter  what  kind, 
is  a  big  business  and  requires  big  men  at  the  head  of  it. 
Early  the  thought  came  to  those  men  that  they  must  have 
a  better  type  of  cattle  and  consequently  the  West  was  soon 
covered  with  purebred  bulls. 

What  is  the  result?  It  has  been  many  years  since  any 
man  on  the  plains  would  think  of  running  his  herd  without 
purebred  bulls.  The  result  of  it  is  that  you  see  on  the  plains 
cattle  that  are  shapely,  of  good  conformation,  of  uniform 
type,  uniform  in  color,  and  in  all  respects  animals  showing 
the  mark  of  intelligent  breeding  by  reason  of  the  fact  that 
bulls  of  the  right  character  have  been  used  upon  these  herds. 

Now  what  is  the  advantage  of  this?  Is  it  worth  all  that 
is  put  into  the  business?  Is  it  worth  the  expense  to  have 
them  look  better,  to  have  them  more  uniform  in  shape  and 
color?  Those  are  the  obvious  facts.  Of  course  that  isn't 
the  point  at  all.  The  point  is  that  the  animal  which  has  been 
produced  by  this  method  of  the  purebred  breeder  is  from  the 
financial  standpoint  a  more  economical  animal.  In  other 
words,  he  is  an  animal  which  transforms  food  into  beef  to  a 
better  advantage. 

Now  that  is  the  whole  thing.  Looks  will  not  help  it. 
Taste  will  not  help  it.  Is  it  a  more  economical  product, 
economical  in  that  sense  of  the  relation  of  the  feed,  length 
of  feeding,  and  the  final  beef?     There  isn't  a  question  about 


AGRICULTURE     AND     I)  A  I  R  Y  I  N  f;  517 

it.  There  would  he  to-day  a  number  of  run-down  herds, 
but  for  the  ])urcl)rcd  sires  that  have  ke])t  up  the  level  all 
the  time. 

Now,  what  about  tlie  dairy  business?  Has  the  dairy 
industry  done  more  than  that?  Take  tliis  question  and 
think  about  it.  Has  the  dairy  industry  done  as  well  ?  Go 
baek,  those  of  you  who  are  old  enough,  to  the  old  herds  of 
cows,  which  were  nondescript  cows,  a  mixture  of  red  cows, 
short-horns,  and  all  those  old-fashioned  kinds  of  cows  in  the 
milk  herds,  and  we  see  them  now  more  or  less.  They  were 
good  cows  to  a  large  extent.  There  were  many  of  those 
herds  that  were  good  herds  of  milking  cows.  As  you  look 
over  the  country,  take  it  at  large  now,  not  the  select  places, 
not  the  experiment  stations,  not  the  few  places  where  the 
dairy  industry  has  been  developed  strong,  but  as  you  look 
at  the  matter  at  large  in  all  the  parts  of  this  State  and  of 
every  other  State,  has  the  type  of  dairy  cattle  improved  to 
correspond  with  the  improvement  in  the  type  of  beef  cattle  ? 

I  think  you  will  answer  in  the  negative.  I  think  that 
you  will  say  that  the  dairy  cows  in  general  have  not  shown 
the  improvement  that  the  beef  animal  has  shown.  And 
then  the  next  question  to  answer  is,  "Why?" 

Certainly  we  have  just  as  much  interest  in  the  dairy 
cows,  certainly  it  is  as  close  a  proposition  to  the  farmer, 
certainly  it  is  a  more  manageable  proposition,  because  it 
works  in  smaller  units  and  is  closer  at  the  hand  of  the  owner. 
And  yet,  the  dairy  cow,  generally  speaking,  has  not  kept 
pace  with  the  beef  cattle  in  development. 

There  is  only  one  answer  to  that.  There  may  be  various 
causes  for  it,  but  there  is  just  one  answer,  and  that  is,  that 
there  has  not  been  the  conception  on  the  part  of  the  dairy 
farmer  as  to  what  he  wanted  or  what  he  ought  to  have, 
that  there  has  been  in  the  mind  of  the  beef  man. 

In  the  second  place,  the  dairy  farmer  running  a  small 
business  on  a  small  margin  of  profit,  and  really  financially 
hard  up  all  the  time,  has  not  had  the  spirit  or  the  courage, 


5i8  HENRY     BAIRD     FAVILL 

or  the  intelligence,  whatever  it  may  be,  to  put  good  pure- 
bred sires  on  his  herd  and  keep  them  there.  Now,  that  is 
the  fact  and  that  is  the  reason  why  there  is  the  very  distinct 
difference  between  dairy  and  beef  improvement,  between 
the  dairy  type  as  compared  to  the  beef  type.  I  don't  believe 
we  dair\^men  particularly  like  to-  face  that  fact.  I  don't 
think  that  we  are  particularly  proud  of  these  facts,  but  the 
facts  remain. 

What  can  be  done  about  this  situation?  What  is  being 
done?  The  first  question  that  comes  to  my  mind  is  this: 
Is  it  worth  while  ?  Is  it  worth  getting  underneath  this  whole 
dairy  question  and  struggling  for  its  uplift  in  general  ?  What 
do  we  mean  when  we  talk  about  the  dairy  type  or  the  dairy 
cow  not  having  kept  pace  with  the  beef  animal?  What  do 
we  mean  by  that  ?  We  mean  that  it  does  not  show  the  same 
improvement  in  form,  in  a  measure,  but  after  all  that  isn't 
the  gist  of  it.  With  beef  animals  we  are  talking  about  their 
capacity  to  lay  on  fiesh  economically.  With  dairy  animals 
we  are  talking  about  their  capacity  to  make  milk  economi- 
cally. Two  very  different  questions,  susceptible  of  exactly 
the  same  reasoning  as  to  principles.  The  same  reasoning 
that  determines  the  improvement  in  conformation  of  a  beef 
animal,  of  course,  determines  the  improvement  in  the  con- 
formation of  the  dairy  animal. 

But  is  conformation  an  important  question  in  the  dairy 
type?  Once  in  a  while  you  will  find  a  difference  of  opinion 
about  that,  but  not  very  often.  There  isn't  any  question 
that  there  is  a  certain  type  of  dairy  animal  that  is  better 
than  other  types.  There  isn't  any  question  about  there 
being  a  real  dairy  type,  not  merely  as  a  matter  of  having 
a  better  form,  but  because  there  is  a  correspondence  between 
form  and  function.  There  is  a  correspondence  between  a 
certain  make-up  of  the  animal  and  the  physiological  possi- 
bilities, whether  it  is  laying  on  fat  for  the  beef  animal  or 
whether  it  is  making  milk  for  the  dairy  animal. 

The   same  principle  that   applies  to  the  beef  animals 


A  (;  K  I  C:  ULT  U  K  R      AND      f>  A  I  R  Y  I  N  G  519 

applies  to  the  dairy  ;iiiiiii;ils.  Ijiit  thai  isn't  the  whole  of 
it.  As  a  m.'itt.cr  of  course,  we  have,  in  our  refinement  of 
dairy  cattle,  thou^'ht  of  certain  peculiarities  of  conformation 
upon  which  we  have  laid  a  good  deal  of  stress.  We  talk  a 
lot  of  certain  ])cculiarities  in  the  matter  of  form  that  are  not 
very  important.  There  isn't  any  question  that  the  fashif>n 
runs  in  various  ways  as  to  conformation  in  dairy  animals, 
but  it  hasn't  very  much  dairy  significance. 

There  are  certain  fundamentals  with  reference  to  the  con- 
formation of  dairy  animals  which  are  of  vital  importance 
and  which  we  must  think  of.  You  know  them  just  as  well 
as  I  do.  But  here  is  tlic  first  question.  Do  the  same  prin- 
ciples that  underly  the  inheritance  of  conformation  in  beef 
stock  underly  the  question  of  improvement  through  the 
transmission  of  the  ability  to  produce  milk?  In  other 
words,  is  the  milk  producing  function  transmissible,  just  the 
same  as  conformation  has  been  shown  to  be  transmissible? 

Well,  of  course,  experience  shows  that  that  is  so.  Exper- 
ience has  shown  that  the  capacity  to  influence  the  milk 
tendency  is  a  hereditary  thing,  not  as  truly  and  uniformly 
as  transmissible  a  characteristic,  in  my  mind,  as  conforma- 
tion; nevertheless,  it  is  a  hereditary  charactertistic.  But 
unless  we  are  agreed  that  the  milk  function  will  transmit 
on  as  a  hereditary  process  and  can  be  improved  and  uplifted 
by  the  process  of  breeding,  there  is  no  use  talking  about  it 
any  further. 

Now,  what  is  it  that  we. are  talking  about  transmitting? 
We  are  talking  about  transmitting  a  larger  milk  capacit}^ 
are  we  not?  Well,  now,  that  isn't  really  all  there  is  to  it. 
If  we  transmit  a  larger  milk  capacity  and  transmit  with  it 
a  larger  feed  capacity,  and  we  find  in  the  end  that  the  feed 
required  to  produce  this  extra  milk  costs  more  than  the  milk 
is  worth,  we  would  be  going  backwards  instead  of  forward. 
It  is  a  two-fold  project.  Not  only  must  we  have  bigger 
milk  production,  but  it  must  be  a  bigger  milk  production 
relative  to  the  feed  consumption,  or  we  have  not  gained 


520  HENRY     BAIRD     FAVILL 

anything.  There  is  where  the  purebred  industrv^  is  related 
to  the  dairy  industry.  Leaving  aside  the  question  of  con- 
formation, which  we  aU  ought  to  have  in  mind,  and  keeping 
in  mind  the  economy  of  the  situation,  we  talk  about  the  need 
for  more  milk,  for  more  individual  production  per  cow,  but 
we  are  liable  to  forget  that  unless  more  milk  is  related  to 
relatively  less  feed,  we  have  not  gained  anything. 

Now,  as  a  matter  of  course,  the  big  milker  is  the  big 
eater.  We  all  agree  to  that.  But  does  the  increased  milk 
production  just  correspond  to  the  increased  feed  consump- 
tion, or  is  the  value  of  the  increased  milk  production  of  the 
big  eater  greater  than  the  increased  cost  of  feed?  How 
many  of  us  know  that  in  our  own  operations?  How  many 
of  us  are  taking  any  cognizance  of  it?  That  is  what  the 
experiment  stations  are  doing  for  us.  The  experiment 
stations  are  here  for  the  purpose  of  establishing  those  gen- 
eral facts  in  agricultural  development  to  which  we,  person- 
ally, can  revert  when  we  want  to  decide  any  question  that 
goes  back  to  a  question  of  principle.  These  agricultural 
stations  have  proved  that  the  highly  developed  dairy 
animal,  costing  from  50  to  100  per  cent  more  for  feed, 
will  produce  from  100  to  200  per  cent  more  profit  in 
milk.  Therefore,  here  is  the  question  and  here  is  the 
answer.  Therefore,  the  milk  has  been  worth  the  feed 
and  more.  Thousands  have  answered  the  question  in 
that  way  and  have  added  profit  to  their  business  on 
account  of  the  increase  in  milk  production,  with  a  rela- 
tively low  increase  in  feed.  Then  dairying  is  an  economi- 
cal proposition. 

Well,  there  we  are  started  at  the  bottom  of  this  question. 
There  is  something  that  can  be  accompHshed  by  heredity 
through  proper  breeding,  and  this  something  is  worthy  of 
being  accomplished. 

Those  are  the  facts.  Where  do  we  stand?  Where  do 
we  stand  with  reference  to  purebred  cattle?  Why  do  we 
always   come   back   to   the   question   of   purebred   cattle? 


A  f ;  IM  r  IT  L  TURK     AND     F)  A  I  I<  Y  I  N  G  52  f 

What  is  there  about  purebred  eattlc  difTerent  from  other 
cattle?  Every  one  of  us  knows  that  there  are  grade  cows 
that  are  as  good  as  any  purebred  cow  you  ever  saw.  Every 
one  of  us  knows  that  to  be  a  fact.  Probably  some  one  of 
you  has  a  mixed  herd,  and  lias  in  his  herd,  or  has  had,  a 
grade  cow  that  was  as  good  or  better  than  any  purebred 
cow.  There  is  no  doubt  about  that.  Let  us  not  forget  these 
facts. 

Wherein,  therefore,  is  the  purebred  cow  better  than  the 
grade  animal  for  your  general  purposes?  Necessarily  the 
purebred  is  not  better  than  the  grade.  It  depends  entirely 
upon  the  grades.  I  have  seen  grade  herds  that  would  aver- 
age as  a  milking  herd  better  than  a  purebred  herd  of  the 
same  size.  So  far,  that  isn't  a  complete  answer.  For  a 
man  who  is  running  a  milk  business,  who  has  a  profitable 
milk  business,  I  have  no  reason  to  suppose  that  a  purebred 
herd  is  better  than  the  grade  herd.  Should  he,  if  he  con- 
siders it  advisable  to  keep  a  grade  herd,  keep  a  purebred 
bull,  and  if  so,  why?     Can  you  answer? 

We  have  got  to  go  back  and  consider  some  very  large 
factors  in  connection  with  livestock.  If  we  will  take  the 
great  mass  of  dairy  animals  and  consider  them  as  a-  mass, 
we  can  figure  their  average  worth.  We  will  take  a  group 
of  these  average  animals.  Then  we  will  take  a  group  of 
animals  that  have  been  culled  out  as  being  inferior,  or  below 
the  certain  mark.  We  will  call  this  group  the  inferiors. 
This  is  quite  a  large  group.  Then  we  \\'ill  take  a  group  of 
animals  that  are  above  the  average,  that  are  superior  to  the 
average.  Now  this  group  of  superiors  is  much  smaller  than 
this  group  of  inferiors.  The  number  of  inferiors  is  very 
much  larger,  but  that  does  n't  matter  particularly.  That 
isn't  the  question.  The  question  is  whether  this  group  of 
inferiors  will  continue  to  grow  larger  in  proportion  to  the 
other  groups.  And  the  answer  to  this  question  should 
decide  whether  3^ou  keep  a  purebred  bull  or  not.  ^Mien 
left  to  itself,  will  the  additions  from  the  general  mass  be 


522  HENRY     BAIRD     FAVILL 

greater  to  the  group  of  inferiors,  or  will  the  additions  from 
the  general  mass  be  greater  to  the  group  of  superiors  ?  Left 
to  itself,  there  will  be  a  constant  drift  from  the  average 
toward  the  inferior  and  still  there  will  be  practically  no  ad- 
dition to  the  superior.  There  is  a  large  tendency  to  take 
out  of  the  average  and  add  to  the  "below  the  average," 
and  also  no  tendency  to  take  out  of  the  average  and  add  to 
the  "above  the  average." 

But  this  could  not  be  true  with  all  live  stock.  Why? 
Because  under  the  conditions  under  which  dairy  cows  are 
kept,  the  dairy  business  has  to  go  on.  There  is  no  natural 
selection  that  tends  to  bring  the  superior  animal  up  into 
prominence  and  to  weed  out  the  inferior  animal.  Under 
dairy  conditions,  the  inferior  animal  lives,  breeds,  and  keeps 
on  breeding,  and  stamping  her  influence  upon  the  whole 
industry,  all  the  time  producing  inferiors,  whereas  there  is 
no  influence  under  natural  conditions  that  would  lead  to 
superiors.  Now  that  is  the  result.  What  have  we  done 
about  that? 

We  have  chosen  to  put  intelligence  into  this  matter  and 
make  operative  an  intelligent  selection  where  there  is  no 
natural  selection,  and  that  is  all  the  purebred  business  is. 
The  purebred  business  is  nothing  on  earth  but  the  result  of 
intelligent  selection  which  is  introduced  because  there  is 
no  natural  selection. 

Now  we  come  back  to  the  question  as  to  whether  or  not 
we  want  to  use  a  purebred  bull  on  a  grade  herd.  It  is  con- 
ceivable that  you  can  get  a  grade  bull,  properly  bred,  that 
is  just  as  good  as  a  purebred.  I  wouldn't  dispute  that. 
But  you  have  very  little  means  of  knowing  that  he  is  going 
to  be  as  good  as  a  purebred.  If  you  could  raise  those  bulls 
yourself,  if  you  knew  all  the  conditions  under  which  they 
were  bred,  then  you  would  know  yourself  whether  you  were 
safe  in  using  a  grade  bull  on  your  herd.  But  as  a  matter  of 
fact,  you  don't  go  into  your  own  herd  for  a  bull.  You  go 
out  into  the  world  for  a  bull,  and  you  can't  find  a  grade  bull 


AORICULTURE     A  N  J)      DAIRYING  523 

whose  conditions  of  breeding  and  development  would  be  as 
satisfactory,  as  a  rule,  as  those  in  your  own  herd.  Conse- 
quently, when  you  go  to  select  a  bull  to  put  on  your  herd, 
you  go  to  some  source  of  information  as  to  the  character  of 
the  bull.  That  is  all.  The  reason  you  go  and  look  for  a 
purebred  bull  is  because  you  want  to  know  something  about 
him  and  what  kind  of  a  sire  he  is  going  to  make.  You  want 
to  look  at  a  record  that  has  been  kept.  That  is  why  you 
look  for  a  purebred  bull.  You  are  looking  for  information 
as  to  the  quality  of  the  animal,  not  because  he  is  any  better 
than  the  grade  bull.     Keep  that  fact  in  mind. 

However,  the  general  tendency  of  your  herd  is  to  deteri- 
orate, just  as  I  pointed  out  a  minute  ago.  It  is  a  little  hard 
to  tell  why  that  is  so,  and  it  would  take  quite  a  lot  of  time 
to  go  into  details  about  it.  However,  it  does  deteriorate. 
The  general  fact  is'  that  a  cow's  heifer  will  not  be  as  good  as 
she  is,  unless  there  is  some  special  stimulus  put  into  the 
situation  to  make  her  as  good  or  better  than  her  dam.  It 
is  a  matter  of  utmost  importance  to  you  to  know  that  the 
animal  which  you  bring  into  your  herd  of  dairy  heifers  has 
some  qualities  that  enable  you  to  believe  that  there  will  be 
a  special  stimulus  come  into  your  herd  and  into  your  good 
cow  that  will  make  a  better  heifer  rather  than  a  slightly 
inferior  heifer.  Experience  shows  it.  Millions  of  men  have 
had  grade  cows  that  were  giving  good  results  and  have 
been  disappointed  because  they  have  not  understood  that  a 
great  cow  will  not  produce  a  great  daughter,  unless  there  is 
a  great  stimulus  through  the  bull. 

So  it  seems  to  me  that  the  question  becomes  strictly 
a  question  of  intelligent  thought.  I  regret  to  say  that  we 
are  not  any  of  us  putting  into  this  matter  the  intelligent 
thought  that  we  ought  to  put  into  it.  There  are  so  many 
questions  about  it.  There  are  so  many  doubts  in  our 
minds.  Then  it  is  so  hard  to  tell  what  is  the  best  iamiiy, 
where  the  best  values  lie;  it  is  so  hard  to  tell  these  things 
and  many  more.     Then  again,  money  is  not  as  free  as  water, 


524  HENRY     BAIRD     FA  V  ILL 

and  it  is  hard  to  tell  how  much  to  pay  for  a  bull,  how  good 
a  bull  you  ought  to  have,  or  what  represents  a  given  quality 
of  a  bull.  That  is  just  as  difficult  for  me  to  decide  as  it  is 
for  you.  The  question  before  us  is  one  of  intelligent  thought 
to  be  sure,  but  it  is  also  a  question  of  great  doubt,  and  you 
have  no  more  doubt  in  your  mind  than  I  have  in  mine,  when 
you  have  to  bu}''  a  bull,  or  when  I  have  to  buy  a  bull  for  my 
herd.  It  is  a  serious,  painstaking  question  and  demands 
thought. 

Is  there  a  way  to  proceed  in  the  matter  that  is  safe  and 
judicious?  I  often  recall  my  old  experience  with  purchases 
of  bulls.  The  first  bull  calf  I  ever  bought  cost  me  $i,ooo, 
and  the  next  one  cost  me  $300,  because  his  dam  had  not 
made  a  large  record  at  that  time.  But  when  this  cow  came 
to  herself,  she  became  one  of  the  greatest  cows  of  the  breed. 
I  am  not  at  all  sorry  that  I  purchased  the  second  bull,  which 
only  cost  me  $300.  I  can't  say  that  he  was  better  than  the 
first,  for  that  is  a  thing  which  is  hard  to  determine.  The 
market  is  peculiar.  I  am  only  calling  your  attention  to  the 
irregularities  which  will  help  you  to  see  that  we  are  dealing 
with  a  difficult  proposition.  Sometimes  a  person  gets  dis- 
gusted with  the  whole  business,  because  there  is  so  little 
certainty  about  it. 

I  have  a  bull  calf  in  my  herd,  for  instance,  which  I  value 
at  $500.  I  sold  his  older  brother  for  a  much  smaller  price. 
Why?  Because  in  the  interval  the  dam  of  this  young  calf 
has  made  a  larger  record.  For  this  reason  he  is  worth  five 
or  six  times  as  much  as  his  brother  was  worth  a  year  ago. 
Don't  misunderstand  me.  I  am  not  making  fun  of  the  dairy 
industry.  I  am  calling  your  attention  to  the  conditions 
which  we  can't  grasp.  So  this  brings  us  down  to  a  difficult 
question. 

We  are  agreed  that  we  ought  to  improve  our  dairy  cattle ; 
we  are  all  agreed  that  we  ought  to  get  as  good  a  bull  to  put 
on  our  stock  as  we  can  get,  and  as  good  as  we  ought  to  have ; 
but  the  question  is,  How  good  a  bull  ought  we  to  have? 


A  (;  U  I  ('  U  I.  T  n  R  i:      AND      DAIRYINC;  525 

Tliat  is  one  of  ilu'.  li;inlcsL  (jucstions  to  answer  that  was  ever 
asked  me. 

It  is  customary  to  say,  "Get  the  best  hull  you  can  buy. 
Borrow  money  to  do  it."  I  never  say  that.  I  wouldn't  say 
that  to  any  man,  unless  I  was  convinced  that  it  was  the  thing 
for  him  to  have,  because  the  mere  matter  that  you  have  to 
borrow  the  money  doesn't  make  that  bull  what  you  want. 
It  is  a  very  difficult  question  to  know  how  good  a  bull  one 
ought  to  have.  Of  course,  that  bears  -some  relation  to  the 
character  of  your  herd.  If  your  herd  is  about  as  good  as 
any  purebred  herd,  and  there  are  some  grade  herds  like  that, 
you  can't  get  too  good  a  bull.  Any  bull  that  is  less  than 
that  grade  is  going  to  pull  your  herd  down.  You  can't 
have  a  herd  of  good  grade  cows  that  are  great  big  producers, 
good  dairy  animals,  and  make  that  herd  what  it  ought  to 
be  with  an  inferior  bull.  The  fact  is  that  you  will  have 
great  difficulty  in  finding  a  bull  that  is  good  enough  to 
improve  it,  or  even  maintain  it.  You  will  have  great  diffi- 
culty to  maintain  a  herd  on  that  level,  so  that  the  question 
of  how  good  a  bull  you  ought  to  have  will  depend  to  a  large 
extent  on  how  good  a  foundation  herd  you  have  to  work  on. 

Supposing  the  best  bull  there  is,  in  the  way  of  transmitting 
ability,  could  raise  a  very  ordinary  herd  of  cows,  so  that  the 
next  generation  would  be  on  a  little  higher  level,  and  so  on. 
That  is,  there  would  be  a  gradual  progress  toward  better 
dairy  animals.  The  proper  thing  for  a  dairyman  to  do  is 
to  buy  bulls  as  he  goes  that  are  increasingly  good  rather 
than  to  reach  at  the  top  at  the  very  outset  and  get  the  high- 
est priced  bull  he  can  find,  and  the  highest  grade  of  a  bull  to 
put  on  to  his  cows  before  they  have  reached  the  level  to  profit 
by  this  high  grade  animal.  Therefore,  my  answer  to  this 
question  when  you  ask  how  good  a  bull  a  man  ought  to  have 
is  that  he  ought  to  be  guided  b}^  reasonable  expectations  of 
his  herd.  If  he  has  a  herd  that  he  doesn't  expect  much  of 
he  had  better  get  a  bull  that  is  only  reasonably  above  his 
herd  rather  than  the  topmost  bull,  irrespective  of  price. 


526  HENRY     BAIRD     FAVILL 

I  want  to  say  something  in  regard  to  the  purebred  busi- 
ness from  another  point  of  view.  All  of  us  who  own  dairy- 
cows  have  a  tendency  to  want  to  own  purebreds.  We  have 
cows  that  are  as  good  as  purebreds,  but  we  aren't  satisfied 
until  we  can  get  into  the  class  or  society  of  stock  that  we 
want.  Now  in  this  connection  there  are  two  factors  which 
we  want  to  consider.  You  become  a  breeder  of  pretty  high 
class  stock,  and  you  want  to  be  able  to  sell  your  bulls  for 
better  prices.  Thos^  are  the  two  factors  which  lead  a  man 
into  the  purebred  business.  Of  course,  there  is  the  addi- 
tional factor  that  he  hopes  to  build  up  a  big  herd  of  high 
producing  dairy  cows.  But  for  the  most  part,  the  things 
that  bring  men  into  the  purebred  business  are  those  two 
factors.  There  is  a  great  deal  of  danger  in  becoming  a 
breeder  of  purebred  stock  and  I  want  to  tell  you  why.  One 
day  I  was  talking  to  a  banker.  Two  or  three  of  my  friends 
were  with  him  at  the  time.  In  some  way  we  got  to  talking 
about  the  cattle  question  at  Lake  Mills,  Wisconsin,  and  some 
allusion  was  made  to  the  purebreds.  The  banker  said 
that  the  purebred  business  was  the  ruin  of  the  stock  breed- 
ers. We  asked  why  he  said  that.  He  said  it  was  the  ruin 
of  our  men.  Then  he  named  Mr.  So-and-So,  and  Mr. 
So-and-So,  and  Mr.  So-and-So,  all  of  them  practically 
"broke."  "They  don't  know  it.  They  are  not  as  sound  as 
they  were  when  they  went  into  the  purebred  business. 
They  have  invested  in  purebreds  and  now  they  are  acting 
as  though  they  were  millionaires.  They  must  have  their 
automobiles." 

I  want  to  say  right  here,  that  an  automobile  that  is  used 
to  serve  your  purpose  is  a  wonderful  thing.  So  many  men 
in  the  country  want  an  automobile  in  which  to  run  around 
the  place.  An  automobile  that  is  purchased  to  stimulate 
your  fancies  and  that  is  used  to  stimulate  your  tendency 
to  run  around  is  not  a  good  thing.  There  is  no  doubt 
about  that.  Those  fellows  are  neglecting  their  farms. 
Because  they  had  an  automobile  they  thought  that  they 


AC,  RT  CULTURE     AND     DAIRYING  527 

could  run  two  farms  just  as  well  as  one.  Instead  of  working 
two  farms,  they  are  nei^lecting  both  of  them.  They  are  not 
working  either  of  them  the  way  they  should  be  worked. 
That  bunch  of  men,  because  they  got  swelled  up,  and  be- 
cause they  neglected  their  farms  and  because  they  thought 
the  whole  thing  was  the  purebred,  gradually  began  to  lose 
their  credit,  and  justified  the  banker  in  saying  that  the 
purebred  business  was  the  ruin  of  those  men. 

If  you  do  it,  the  same  thing  is  liable  to  happen.  There 
seems  to  be  a  kind  of  a  vanity  about  it  that  makes  some 
people  swell  up  and  it  over-stimulates  them.  Some  one  has 
said  that  it  beats  a  horse  race  all  to  pieces.  There  is  no 
doubt  about  that.  When  you  come  to  an  official  test, 
every  milking  is  looked  forward  to.  It  is  the  most  enthu- 
siastic thing  you  ever  encounter  on  a  farm.  When  the  test 
is  getting  up  into  a  high  class,  there  is  a  legitimate  excite- 
ment about  it. 

And  now,  beside  that  feature  of  the  purebred  business, 
there  is  a  tendency  to  magnify  the  herd  at  the  expense  of 
the  farm.  That  is  the  second  thing  that  I  want  to  speak 
about.  The  man  who  does  n't  regard  his  herd  of  dairy  cows, 
be  they  grade  or  purebred  breeding  cattle,  as  the  hand- 
maiden of  the  farm,  as  the  assistants,  as  the  side  issues  of 
the  farm,  and  which  is  only  a  means  of  building  the  farm 
up  to  its  highest  possibilities,  ought  to  fail,  and  he  probably 
will.  For  after  all,  it  is  the  farm  that  counts  and  not  the 
herd  that  is  on  it.  It  is  the  farm  that  makes  the  farmer 
and  not  the  herd.  In  the  long  run,  take  the  country- 
through,  there  will  be  no  great  breeders  except  those  that 
are  great  farmers,  because  the  herd  is  subordinate  to  the 
farm  and  is  used  for  the  purpose  of  magnifying  the  farm. 

That  is  the  essence  of  the  whole  question.  That  is  the 
question  that  is  before  the  breeders,  that  is  before  the 
teachers,  and  that  is  before  the  young  men.  Are  you  going 
to  regard  this  thing  from  the  standpoint  of  your  farm;  are 
you  going  to  regard  yourself  from  the   standpoint  of   a 


528  HENRY     BAIRD     FAVILL 

farmer,  and  make  all  these  other  things  subordinate  to  the 
farm;  or,  are  3^ou  going  to  disown  your  farm  and  your 
business  and  your  community  and  run  everything  for  the 
sake  of  magnifying  that  which  is  really  a  side-issue  of  your 
business,  your  dairy  stock,  your  dairy  herd,  or  your  dairy 
breeding  business? 

That  is  the  question  that  we  must  face.  It  is  so  crucial 
that  one's  conception  of  the  relation  of  his  farm  to  his  herd, 
or  his  herd  to  his  farm,  will  determine  whether  he  is  going 
to  be  a  success  in  his  business.  Let  us  not  forget  that  one 
thing.  This  country  is  made  up  of  individuals  of  whom 
you  are  members  and  representatives,  and  this  country  is 
hanging  in  the  balance  agriculturally.  We  think  we  are 
the  greatest.  We  have  overshot  ourselves  in  the  respect 
of  immediate  production  and  we  are  not  keeping  up  the 
fertility  of  our  land,  and  the  result  of  this  is  that  our  rela- 
tively high  agricultural  supremacy  is  going  down.  And 
it  is  going  to  continue  to  go  down,  unless  we  get  busy.  That 
means  that  every  man  must  regard  his  farm  as  primary, 
and  if  he  has  a  herd  of  great  cattle,  he  must  regard  this  herd 
as  secondary.  If  this  herd  is  not  secondary  and  is  not  made 
to  serve  the  purpose  of  the  building  up  of  his  farm  and  his 
agriculture,  he  is  not  only  failing  for  himself,  but  also  for 
his  offspring.     That  is  the  way  I  look  at  it. 

There  is  one  other  aspect  of  this  purebred  business  that 
I  want  to  warn  you  about,  and  that  is  with  regard  to  the 
speculative  point  of  view.  A  man  goes  out  to  look  around 
for  a  sire  for  his  herd  and  he  says  he  wants  such  and  such  a  sire. 
Now,  one  man  will  say  that  he  wants  a  bull  that  is  going  to 
build  up  his  herd  and  make  it  a  great  herd  of  dairy  cows. 
That  man  is  safe.  The  next  man  will  say  that  he  wants  a 
bull,  no  matter  how  old  or  how  young  he  is,  that  is  so  con- 
spicuous and  so  well  advertised  that  his  offspring  will  sell 
for  very  high  prices,  and  he  is  willing  to  pay  out  a  large 
price  for  that  bull,  whether  he  is  any  good  or  not.  That 
man  is  unsafe.     The  first  man  is  a  breeder.     The  second 


A(;  K  I  C  U  LT  n  R  IC      AND     I)  A  I  I<  V  I  N  G  529 

man  is  a  speculator.  I  hate  to  use  that  last  wonl,  hut  after 
all,  that  is  all  he  is.  Now,  gentlemen,  we  all  do  that  in  a  way. 
I  am  not  saying  that  it  hasn't  been  done  by  some  of  us.  It 
is  the  nature  of  the  business  to  do  it.  You  can't  help  it  if 
you  try.  ^i'hc  question  is  whether  or  not  that  is  the  predom- 
inant motive. 

The  future  before  the  young  breeder  who  has  respect 
for  his  general  agriculture,  and  is  willing  to  protect  it,  and 
who  wants  to  breed  good  animals  and  who  will  let  the  specu- 
lative part  alone,  the  future  for  that  man  is  the  brightest 
future  that  I  know  of  anywhere.  That  is  my  full  belief  on 
the  subject. 


530  HENRY     B  A  I  R  D     F  A  V  I  L  L 


Delivered,     Thirty-first     Annual     Convention     Nebraska     Dairymen's 

Association,  State  Farm,  Lincoln,  Neb.,  January  20,   1916. 
Printed,  report  of  meeting. 

THE  DEVELOPMENT  OF  THE  DAIRY  INDUSTRY 

IT  is  always  a  little  difficult  to  explain  why  a  practicing 
physician  should  be  brought  off  on  a  long  trip  to  talk 
on  a  technical  subject  that  presumably  is  better  under- 
stood by  nine-tenths  of  his  audience  than  by  him.  I  am 
not  going  to  go  into  an  explanation  of  that  subject,  except 
to  say  that  I  have  gotten  into  the  habit  of  being  called  upon 
for  a  good  many  different  functions;  in  fact  I  always  think 
of  myself  in  that  connection  in  the  same  manner  as  a  Chicago 
judge  was  regarded.  One  of  our  very  learned  men,  Mr.  Em- 
ory Story,  a  witty  lawyer  and  a  scholarly  man,  was  asked 
his  opinion  of  the  judge.  Mr.  Story  answered  in  a  way 
at  least,  saying,  "Yes,  the  judge  is  a  man  of  broad  and  com- 
prehensive ideals,  who  knows  less  about  more  things  than 
any  man  that  ever  sat  on  the  bench."  I  often  feel  that 
might  hit  me  if  I  keep  on  covering  territory  in  the  various 
fields  that  I  get  into.  But  I  have  a  little  feeling  that  this 
occasion  is  different,  I  judge  so  at  least,  by  my  internal 
feelings. 

This  morning  I  was  shocked  and  almost  hurt  to  hear 
my  friend  Mr.  Wilkenson,  who  is  responsible  for  bringing 
me  out  here,  say  that  the  doctor  had  dairying  as  a  side  line. 

Now,  if  dairying  is  my  side  line,  I  want  it  to  be  under- 
stood that  day  is  about  over;  I  won't  have  it  alluded  to  as 
my  side  line,  whatever  it  may  be  as  to  the  disposition  of 
my  time  or  perhaps  as  to  the  production  of  my  income,  it 
certainly  is  not  a  side  line  as  to  the  intensity  of  my  interest. 
I  come  to  you  from  another  standpoint  than  that  of  a  small 
dairyman.  I  have  gotten  involved  lately  in  the  organiza- 
tion end  of  the  dairy  business  —  I  refer  now  to  the  com- 
paratively new  but  ambitious  organization  known  as  the 


A(;riculture    and    da  ikying         537 

National  Dairy  Council  — an  organization  which  has  charged 
itself  with  the  harmonizing,  amalgamating,  and  rendering 
effective  the  varioUvS  branches  of  the  dairy  industry.  But  I 
am  not  going  to  talk  to  you  now  about  the  Council ;  I  simply 
call  your  attention  to  the  fact  that  that  is  the  avenue  through 
which  I  come  to  you  to-day;  it  is  because  of  circumstances 
related  to  the  Council,  that  I  am  here  to-day.  And  it  is 
because  of  the  point  of  view  thjit  I  have  acquired  in  connec- 
tion with  that  great  attempt  to  do  something  by  which  the 
whole  industry  can  be  generalized  and  the  Council  made  to 
do  effective  work  for  the  dairy  industry,  that  I  feel  myself 
at  liberty  to-day  to  presume  to  talk  to  you  about  a  big 
broad  view  of  the  dairy  industry.  I  do  not  wish  to  speak 
from  the  standpoint  of  any  limited  dairy  point  of  view,  but 
about  the  development  of  this  enormous  industry  which  I 
don't  hesitate  to  say  to  you  is  the  greatest  and  most  im- 
portant single  industry  in  this  country. 

One  can  not  look  into  the  question  of  the  future  of  dairy- 
ing without  undertaking,  if  possible,  to  analyze  the  thing 
down  to  its  smallest  terms,  because  when  you  view  the 
industry  from  its  final  terms  in  its  large  development,  in 
its  higher  branches  of  commercialism,  you  find  the  subject 
so  complex,  so  inter-communicative,  so  inter-locked  in  all 
business  ways,  it  is  almost  impossible  to  talk  about  the  thing 
in  any  clearly  analytical  way.  It  is  only  as  you  reduce 
the  industry  down  to  its  smallest  terms  that  you  can  get 
any  kind  of  grasp  of  the  situation  from  which  to  start 
towards  a  conception  of  the  dairy  industry,  and  it  is  -udth 
reference  to  this  analysis  that  I  use  the  term  "dair>^  unit." 

By  the  dairy  unit  I  do  not  mean  the  single  dair>"  farm 
which  is  frequently  alluded  to  as  the  basis  of  our  calcula- 
tions. I  go  beyond  that  and  say  —  the  unit  of  the  dair}- 
business  is  the  cow.  The  sooner  we  get  to  the  point  of 
view  that  our  calculations  must  start  from  the  cow,  must 
correlate  to  the  cow,  the  surer  we  will  be  that  w^e  are  on  a 
sound  ground  of  reasoning  as  to  this  dairy  industry. 


532  HENRY     BAIRDFAVILL 

Well,  what  do  I  mean  about  the  cow  ?  It  is  an  old  story 
to  you  and  I  don't  want  to  worr}^  you  with  talk  about  the 
cow ^^- that  is,  of  course,  a  profitable  cow  —  I  don't  want 
to  go  on  'and  repeat  to  you  all  of  the  things  that  have  be- 
come axiomatic  with  reference  to  the  fact  that  there  is  a 
profitable  and  an  improfitable  cow.  I  don't  need  to  argue 
with  you  about  the  general  proposition  of  carrying  un- 
profitable cows.  But  after  all,  you  and  I  know  that  that 
question  of  the  unprofitable  cow  has  not  yet  been  impressed 
upon  the  people  of  this  country  at  all.  The  fact  that  you 
know  it  and  that  I  know  it  does  not  in  any  sense  solve  the 
problem.  The  question  is,  What  are  you  and  I  doing  with 
our  knowledge,  our  information,  and  our  convictions  upon 
that  subject?  Are  we  carrying  the  propaganda  on  this 
subject  of  the  profitable  and  unprofitable  cow  to  the  place 
where  it  has  got  to  go  to  be  worth  anything  finally  as 
propaganda  ? 

In  other  words,  I  am  here  to  impress  upon  you  as  to 
what  you  shall  do  with  what  you  know,  rather  than  to 
try  to  bring  you  anything  that  you  don't  know,  and  that 
is  the  gist  of  this  whole  question  of  pushing  our  industry. 

Now,  bear  in  mind  the  mere  question  of  whether  the 
cow  is  producing  enough  milk  to  pay  you  for  her  feed  is  not 
the  sole  question  from  an  economic  standpoint,  but  it  is  an 
unavoidable  question.  There  is  no  use  considering  the  value 
of  a  dairy  cow  that  is  not  producing  more  milk  than  enough  to 
pay  for  her  feed.  You  say  there  are  other  factors.  There  is 
the  question  from  the  standpoint  of  soil  fertility,  the  ques- 
tion of  manure,  and  there  is  the  offspring,  things  that  have 
to  do  with  her  profit.  It  goes  without  saying,  that  the  dairy 
cow  has  got  to  make  milk  enough  to  pay  far  more  than  for 
the  feed  she  uses.  Do  you  not  know  —  every  practical 
feeder  does  know  — that  the  profitable  cow  pays  for  feed 
liberally,  and  that  the  more  profitable  a  cow  you  have,  the 
more  you  will  find  she  pays  a  profit  on  all  the  feed  she  can 
be  given?     That  is  the   final  test  of  profitableness — her 


A  <;  N  I  ('  I)  I.  T  (I  U  I'".      AND      f)  A  r  R  Y  r  N  G  .<;33 

capacity  of  iiKTcasin^  returns  upon  I, ho  feed  she  eats. 
Let  lis  look  at  that  a  moment;  we  don't  want  to  talk 
any  nonsense  here;  we  want  to  take  the  last  view  about 
this  thinjT.  What  do  your  dairy  j)apers  tell  you?  What  do 
your  agricultural  schools  tell  you  i'  Of  course  lots  of  things, 
friends,  but  once  in  a  while  they  will  tell  you  this:  If  you 
can  feed  corn  and  alfalfa  you  have  a  balanced  ration,  and 
they  imply  that  is  all  you  have  to  do  to  run  a  dairy,  yet 
you  have  only  to  turn  over  the  page  and  you  are  advised  to 
feed  so  and  so  much  concentrates,  according  to  the  supply 
of  milk.  What  they  really  mean  finally  to  say  is  that  good 
producing  cattle  will  pay  you  a  profit  on  the  grain  that  you 
buy  and  feed  them,  to  say  nothing  of  that  which  you 
raise;  so  that  this  question  becomes  in  the  large  the 
question  of  every  man  who  has  any  surplus  grain,  more 
than  is  necessary  for  human  consumption,  who  is  in- 
terested in  the  quality  of  the  dairy  cow  he  possesses, 
because  the  only  place  where  grain  that  is  not  neces- 
sary for  human  consumption  can  profitably  go  is  to  feed 
stock  of  some  kind.  The  purpose  to  which  we  would 
put  this  feed  naturally  is  the  one  upon  which  we  are 
speaking,  and  which  is  of  preponderating  importance  in 
this  respect  to  us.  This,  of  course,  ramifies  and  ties  us  to 
another  important  matter,  and  that  is  the  question  of  the 
fertility  of  the  land  —  a  thing  that  we  have  adopted  as  the 
A  B  C  of  agricultural  schools.  The  conviction  that  the 
future  of  the  soil  of  this  country,  as  to  fertility,  is  dependent 
upon  animal  manure,  is  well  established  in  us.  We  have 
accepted  it.  And  I  come  here  to-day  preaching  upon  that 
old  ground  that  you  know  just  as  well  as  I  do,  because  I 
know  that  however  well  you  may  be  conviced  of  the  fact, 
the  country  at  large  is  not  convinced  of  it.  W"e  have  paid 
the  price  in  a  thousand  different  spots  in  this  countr\-  for 
not  having  convictions  on  the  subject.  It  has  been  known 
in  New  England,  New  York,  North  Carolina,  Georgia. 
Louisiana,  and  Texas  from  time  immemorial  that  without 


534  HENRY     BAIRD     FA  V  ILL 

proper  fertilization  of  your  land  it  will  run  down  in  pro- 
ductiveness, and  in  spite  of  all  our  knowledge  the  land  has 
gone  down  in  productiveness.  You  and  I  know  that  it 
is  not  a  hew  story,  but  no  matter  how  well  we  understand 
it  ourselves,  the  country  at  large  has  not  adopted  it  as  a 
working  formula. 

Now  the  question  is,  whether  a  State  like  Nebraska, 
with  its  resources  of  grain,  hay,  and  everything  that  you  can 
take  off  the  soil  direct  to  market,  should  be  so  treated,  or 
whether  this  great  State  is  going  to  learn  the  lesson  of  soil 
fertility  as  other  States  have. 

There  is  another  great  question,  but  it  is  a  little  more 
of  a  personal  question,  which  apphes  to  all  men  who  are 
annually  rearing  purebred  cattle :  Do  we  understand  fully 
that  the  only  excuse  for  our  being  in  the  purebred  cattle 
business  is  the  grade  cow? 

Do  we  really  understand  that,  until  the  product  of  our 
best  efforts  of  money  and  brains  is  embodied  in  the  product 
of  our  purebred  cattle,  and  until  that  product  is  distrib- 
uted upon  the  grade  cows  of  this  country,  we  have  accom- 
plished nothing?  And  up  to  that  point,  but  stopping  short 
of  that  point,  we  are  playing  nothing  but  an  interesting 
game.  Do  we  realize  that  the  purebred  business  has  no 
possible  foundation  except  as  to  its  value  to  the  grade 
cattle  business,  or  until  the  young  bulls  we  raise  are  dis- 
tributed among  the  grade  herds  of  this  country?  Until 
then,  we  have  accomplished  nothing,  and  we  might  as 
well  be  out  of  the  business.  We  must  make  the  farmers 
realize  this. 

In  my  own  State  of  Wisconsin  there  are  not  25  per  cent  of 
the  herds  headed  by  purebred  bulls.  It  is  largely  because 
the  purebred  men  are  not  holding  the  real  thought  of  their 
work  before  themselves.  We  are  apt  to  be  carried  away 
by  the  high  tests,  beautiful  shows,  big  records,  big  prices, 
as  well  as  all  excitement  and  interest  that  occurs  in  the 
purebred  industry,  and  to  forget  that  behind  it  all  lies  the 


A(i  HI  CULTURE     AND      DAIRYING  535 

grade  cow,  and  tnilil  wc  have  contributed  to  upliftinj^ 
the  grade  cow,  we  have  accomph'shed  nothing.  Let  us  not 
forget  that  there  is  a  philosophy  in  this  purebred  business 
which  must  be  observed  and  elevated  before  it  makes  the 
whole  thing  transparent. 

With  these  thoughts,  these  ideals  before  me,  you  can 
see  why  I  talk  al)Out  the  dairy  unit  being  a  matter  of  im- 
portance. I  can  see  the  whole  thing  tied  together.  I  see 
another  thing  before  me:  I  can  see  better  farm  buildings; 
better  conditions  under  which  cows  shall  be  housed;  I  find 
more  sanitary  ideas  underlying  the  whole  installation  of  the 
dairy  farm;  I  see  the  question  of  greater  cleanliness  in  the 
handling  of  the  dairy  products  on  the  farm. 

I  am  going  to  talk  more  about  that  later,  because  I  am 
interested  in  the  remarks  of  Mr.  Hammond.  I  am  look- 
ing forward  to  the  time  when  the  average  dairy  farmer  will 
be  a  clean  individual.  Why  not?  There  is  no  reason  why 
not.  It  is  not  expensive;  what  you  must  have  is  a  clean 
conception;  it  doesn't  mean  a  great  expense,  big  equip- 
ment, and  expensive  installation.  It  means  a  clean  con- 
ception. 

And  then  I  am  looking  forward  to  the  time  when  there 
will  be  care  outside  of  the  pioduction  end;  when  there  will 
be  intelligent  care  all  along  the  line;  when  there  will  be 
real  recognition  of  the  fact  that  our  industry  depends 
entirely  upon  cleanliness. 

I  may  be  looking  for  the  millenium,  but  I  expect  the 
dairy  situation  to  improve  a  little  before  the  millenium, 
and  I  think  the  history  of  the  industry  in  the  last  ten  years 
justifies  it. 

When  we  stop  to  consider  what  the  changes  have  been 
in  the  dairy  industry  in  the  past  ten  years  and  compare  it 
with  the  previous  season  of  50  or  30  or  even  20  years,  vou 
see  the  situation  is  not  w^ithout  hope.  There  are  things 
that  still  can  be  done  for  improvement  because  things  have 
been  done  without  half  trying.     But  there  is  one  thing  I 


536  HENRY     BAIRD     FAVILL 

want  to  say  to  3^ou,  and  it  is  this  that  leads  me  to  come  to 
these  meetings,  particularly  where  there  are  young  men, 
young  farmers,  the  thing  that  is  going  to  determine  this 
subject  as  to  the  future  of  dairying  is  going  to  be  twofold. 

It  is  going  to  be  in  the  first  place  a  deep  respect  on  the 
part  of  the  dair^^man  for  his  calling.  There  is  n't  a  whole 
lot  of  romance  running  through  the  daily  life  of  the  dairy 
farmer  when  you  come  to  consider  what  he  has  to  do  and 
how  he  has  to  do  it,  particularly  if  he  is  short  of  money  and 
has  other  adverse  conditions  to  struggle  with.  But  let  me 
say  to  you,  as  a  great  foundation  principle  of  the  psychology 
of  the  human  race,  that  just  the  minute  you  inject  into 
a  subject  a  factor  of  real  interest,  intellectual  interest,  just 
at  that  minute  you  begin  to  dignify  and  uplift  that  subject. 
Of  the  things  that  are  recommended  with  reference  to  the 
dairy  cow,  one  of  the  most  important  is  weighing  your  milk. 
If  you  have  never  weighed  it  before  you  will  find  it  puts 
the  element  of  interest  into  dairying  that  the  average 
dairyman  never  saw  in  it,  and  when  you  go  beyond  that 
and  assay  the  milk  as  to  the  butter  fat  it  contains,  you 
put  into  your  proposition  an  interest  that  never  was  in  it 
before. 

When  you  begin  to  breed  intelligently  so  that  you  take 
your  cows  of  a  given  breed  and  estimate  them  in  the  light 
of  their  progeny,  you  inject  another  most  interesting  ele- 
ment that  never  was  in  it  before.  And  by  the  time  you 
carry  the  larger  ideas  of  your  business  on  and  on  and  on, 
through  the  intellectual  factor,  you  will  find  when  you  get 
to  the  top  you  have  the  most  intellectual  agricultural  prob- 
lem that  was  ever  brought  before  the  human  mind,  and  I 
undertake  to  say,  one  of  the  most  appalling  intellectual 
problems  that  ever  occupied  the  hiiman  mind  in  any  direc- 
tion. I  am  not  exaggerating  at  all  when  I  say  that  I  believe 
the  dairy  farm  offers  a  larger  field  and  makes  a  deeper 
impression  on  the  mind  than  any  one  avocation  I  have 
known  anything  about,  and  I  fully  believe  it. 


A(;  R  I  C  U  I.  T  n  R  K      AND     DAIRYING  537 

Now,  gentlemen,  1,1i;lI  ])c\u^  Uk;  case,  do  you  see  that 
the  way  to  bring  up  the  respect  for  the  business  is  to  bring 
into  it  intellectual  factors,  and  that  means  only  to  do  it 
right.  I  don't  care  whether  you  are  in  a  grade  business  or 
a  purebred  business,  the  thing  only  needs  to  be  done  prop- 
erly to  become  an  entrancing  business  in  a  larger  way. 

The  other  factor  in  carrying  on  a  dairy  business 
successfully  is,  faith  in  the  future,  faith  in  the  industry. 
You  take  an  old  dairy  State  like  Wisconsin  that  is  instilled 
with  the  spirit  of  dairying  and  they  never  have  their  faith 
particularly  shaken;  they  sometimes  growl  about  it  but 
they  go  right  on  dairying  because  it  has  made  Wisconsin 
what  it  is;  but  you  take  a  new  State  like  Nebraska,  which 
has  been  one  of  our  prosperous  commonwealths,  one  of  the 
biggest  grain  sellers  and  money  getters  in  the  world,  and  is 
moving  along  towards  a  great  commonwealth,  but  which 
is  not  particularly  a  dairy  State,  and  you  will  find  that  the 
farmer  is  disposed  to  scrutinize  the  dairy  proposition  care- 
fully when  he  considers  changing  his  mode  of  living,  as  he 
must  do  when  he  starts  a  dairy  proposition.  It  is  a  close 
proposition  without  any  great  sales  or  profits,  and  it  takes 
him  a  long  time  to  make  up  his  mind  to  be  a  dairy  farmer. 
When  he  does,  what  are  the  reasons  that  lead  him  to  take 
up  dairying?     There  are  two,  at  least. 

First,  he  observes,  if  he  is  going  to  live  on  the  land  profit- 
ably he  must  have  fertile  land ;  he  must  not  rob  his  soil  any 
more,  and  for  that  reason  the  dairy  business  is  the  answer. 

Or  he  may  say,  as  Mr.  Marsh  was  pointing  out  to  me 
in  a  conversation  we  had, — that  dairying  is  a  resource  and 
a  salvation  from  adversity.  When  you  get  in  hard  lines, 
or  in  deep  water  financially;  when  returns  are  low  and 
everything  is  dragging  a  little  instead  of  on  the  highway 
of  success;  that  is  when  a  man  turns  to  dairying,  because 
it  is  a  definite  and  certain  means  of  getting  ahead,  not  by 
leaps  and  bounds,  but  by  careful  and  s^^stematic  upbuild- 
ing.    Those  two  things  are  what  bring  men  into  the  dairy 


538  HENRY     BAIRD     FA  V  ILL 

business  in  a  new  country.  And  the  next  to  those  impor- 
tant things  is  faith  in  the  business,  and  that  really  is  the 
great  big  predominant  thing;  they  must  feel  absolutely 
certain  that  the  business  will  go  on;  if  they  were  students 
of  history  they  would  read  that  every  great  country  de- 
veloped through  agriculture  and  dairying.  They  may 
say,  Yes,  dairying  is  sure  to  go  on;  but  it  isn't  right 
before  them  and  so  they  don't  see  it.  Therefore,  the  time 
has  come  when  the  dairyman  in  every  branch  of  the  in- 
dustry must  see  that  he  is  closely  tied  to  the  whole 
progress  of  dairying;  and  that  the  great  middlemen,  great 
centralizer  people,  the  great  milk  producers,  milk  distrib- 
utors in  the  city,  and  manufacturers  of  milk  powders, 
cheese,  and  what-not,  have  become  factors  upon  which 
the  dairy  business  is  going  to  be  dependent.  They  are 
dependent  on  the  dairy  business  and  the  dairy  business 
is   dependent  upon  them.     And  what  does  it  mean? 

We  have  just  been  studying  this  phase  of  the  subject 
in  the  Dairy  Council.  It  means  that  not  the  dairyman 
alone,  no  matter  what  his  grade,  his  quality,  or  what  the 
care  of  his  milk  is,  is  dependent  upon  certain  other  impor- 
tant factors  to  maintain  the  advantage  he  gets  out  of  them. 
In  other  words,  the  transportation  companies,  handlers, 
manufacturers,  and  cattle  breeders  have  all  got  to  recognize 
their  responsibilities  in  making  this  whole  scheme  of  dairy- 
ing successful.  There  is  no  such  thing  as  a  separate  interest 
in  this  business.  We  must  all  work  together  in  building 
the  industry  in  every  possible  manner,  and  that  brings  us 
to  another  important  thought :. 

What  is  the  future  market  for  dairy  products? 

Now,  gentlemen,  this  is  a  great  big  question,  and  it  is 
before  us.  Is  the  consumption  of  dairy  products  what  it 
ought  to  be  to-day?  You  know  perfectly  well  it  is  not. 
You  know  perfectly  well  there  is  no  rule  in  regard  to  the 
consumption  of  dairy  products  to-day;  there  ought  to  be. 
What  is  going  to  make  the  market  bigger?     We  maintain 


A  (;  R  F  (•  n  [.  'I  (•  R  i<;    and    d  a  i  k  \-  f  \  (.  ^yj 

that  th(!  husincss  interests  that  stand  between  the  cow  and 
the  public  have  got  in  some  way  or  other  to  increase  the 
market  for  the  dairy  cow's  product, --a  market  that  will 
give  the  man  who  milks  the  cow,  confidence  in  the  future. 
We  maintain  that  tlic  market  is  the  especial  business  of  the 
manufacturer  and  distributor,  and  until  he  ?msies  himself 
with  making  a  market  for  the  dairy  products,  there  is  no 
security  in  the  dairy  business,  and  that  I  don't  hesitate  to 
say.  There  is  no  security  in  the  dairy  V)usiness  until  the 
markets  arc  on  a  better  stabilized  basis. 

Why  should  we  feel  justified  in  trying  to  stimulate  the 
market  for  milk  and  its  products? 

In  the  first  place,  from  the  standpoint  of  the  human  race 
it  is  the  best  food  there  is,  in  many  respects,  and  also  be- 
cause, from  the  standpoint  of  special  nutritive  values,  it 
alone  fills  the  bill  for  human  consumption. 

The  second  reason  is  that  at  present,  even  under  the 
present  adverse  conditions,  it  is  the  cheapest  food  of  its 
character  that  is  known. 

Now,  for  these  two  reasons,  strictly  in  the  interests  of  the 
public,  and  not  in  the  interests  of  the  cow  men,  or  daiiy- 
men,  or  butter-men,  or  middlemen,  that  market  ought  to  be 
stimulated.  Will  our  people  see  the  need  of  taking  up  this 
work?  I  think  they  will,  for  this  reason  —  I  have  hinted  at 
it  before  —  the  future  of  agriculture  in  the  United  States 
is  absolutely  tied  up  to  animal  husbandry.  I  won 't  just 
say  dairy  cows,  but  I  do  say  that  the  great  agricultural 
supremacy  that  the  United  States  holds  to-day  can  only 
be  maintained  by  a  broad  and  comprehensive  policy  of 
animal  husbandry'.  The  dain,"  farmer  is  not  responsible 
for  the  countr}^  —  none  of  us  are  —  but  it  becomes  a  great 
question  of  national  policy;  and  here  is  what  I  would  call 
your  attention  to  particularh''  to-day:  Is  the  national 
polic}^  of  this  countr\^  thoroughly  and  intelligently  directed 
towards  the  improvement  of  animal  husbandr\^? 

I  will  answer,  yes,  in  certain  directions,  it  is.     So  far 


S40  HENRY     BAIRD     FAVILL 

as  its  agricultural  department  is  concerned,  it  is  intensely- 
directed  towards  the  uplift  and  welfare  of  animal  husbandry. 
But  so  far  as  its  legislation  is  concerned;  so  far  as  its  cre- 
ation of  public  opinion  is  concerned  —  I  can't  say  it  is  hos- 
tile—  it  is  very  indifferent.  I  don't  believe  that  the  admin- 
istrative or  legislative  functions  of  this  country  are  in 
any  large  way  keenly  aware  of  the  fact  that  animal  hus- 
bandry underlies  our  national  prosperity.  I  don't  believe 
they  see  it,  but  so  clear  is  it  to  those  who  think  about  it 
that  it  seems  almost  beyond  argument;  and  yet,  while  I 
did  not  come  here  to  talk  politics,  I  would  say  that  perhaps 
I  am  a  free-trader,  at  any  rate  I  have  been  a  comparatively 
low  tariff  advocate.  But  this  question  of  the  relation  of 
dairy  products  to  the  tariff  must  be  seen  to"  intelligently ; 
it  is  far-reaching.  It  is  all  right-  to  say  a  commodity  must 
be  produced  where  it  can  be  produced  the  cheapest,  that 
is  the  economic  law  of  the  world;  I  will  accept  that  for  the 
time  being,  if  you  like ;  but  I  want  to  say  that  this  question 
of  dairy  products  is  absolutely  a  different  question  from  the 
question  of  any  other  known  commodity.  Even  our  agri- 
cultural products,  such  as  grain,  cotton,  and  tobacco  are 
protected,  and  they  all  have  a  certain  commercial  value 
with  reference  to  this  question;  but  when  it  comes  to  the 
question  of  dairy  products,  the  question  becomes  an  entirely 
separate  question,  because  the  dairy  farmer  needs  to  be 
protected,  because  the  country  needs  what  he  can  produce, 
and  our  soil  demands  that  what  we  consume  be  produced 
on  our  own  lands.  I  will  not  undertake  to  say  what  the 
tariff  should  be,  but  I  will  say  it  ought  not  to  be  regarded 
on  the  basis  of  mere  commercial  competition  with  some 
other  country,  but  from  the  standpoint  of  national  neces- 
sity, and  whatever  is  necessary  to  make  the  raising  of  live 
stock,  particularly  dairy  cattle,  attractive  and  profitable 
to  the  poor  man  who  is  starting  out  in  life,  is  the  thing 
which  in  the  long  run  must  be  considered  to  contribute  to 
national  prosperity.     It  is  no  political  question  at  all.     It 


AGRICULTURK     AND     I)  A  I  K  Y  I  N  f)  541 

is  a  question  of  conservation,  ,'infl  the  question  of  the  sal- 
vation of  this  country.  I  don't  want  to  he  misunderstood 
in  this  at  all;  1  haven't  the  slightest  political  aspirations, 
but  I  want  to  call  your  attention  to  the  fact  that  this  ques- 
tion of  the  tariff  on  dairy  products  is  in  a  sense  by  itself 
and  absolutely  must  be  so  considered.  Another  thing  on 
this  same  line  of  thought  is  this:  Public  o})inion  is  very 
necessary  behind  all  of  this,  and  still  it  is  not  doing  any- 
thing about  it,  because  it  doesn't  care,  it  is  too  far  away; 
all  public  opinion  cares  about  is  the  price  of  butter  and 
milk.  So  great  is  that  fact,  that  whenever  we  come  at  the 
public  with  any  of  our  great  economic  issues  in  which  we 
are  concerned,  we  are  made  to  stand  before  the  public 
simply  on  the  basis  of  commercial  rivals  trying  to  save  our 
trade,  and  the  proper  development  of  public  opinion  can  be 
made  through  our  increased  market  work. 

As  we  now  stand,  the  dairy  business  is  the  subject  of 
two  very  serious  problems.  One  is  the  competition  with  a 
legitimate  food  product — margarine,  or  "oleo,"  as  they  call 
it  now;  that  is,  competition  with  it  on  a  basis  of  misrepre- 
sentation.    The  other  is  the  question  of  health. 

The  dairy  business  and  the  dairy  world  have  no  right 
to  object  to  straight  business  competition  with  margarine. 
There  is  no  ground  upon  which  to  have  any  difference  with 
margarine  except  one,  and  that  you  know  perfectly  well  — 
that  the  effort  in  all  margarine  business  is  to  sell  it  for 
butter,  and  you  know,  as  long  as  it  is  so  sold  it  is  a  war  to  the 
knife  and  should  be  so  with  every  dair>'^man.  As  long  as 
there  is  any  way  to  distinguish  margarine  from  butter,  the 
ultimate  consumer  must  at  all  times  know  what  he  is 
getting,  and  that  will  solve  this  problem.  Who  is  the  ulti- 
mate consumer?  Why,  the  purchaser,  the  manufacturer  will 
tell  you.  That  is  the  argument  from  Washington,  from 
Chicago,  and  elsewhere,  but  that  is  n't  true.  The  ultimate 
consumer  is  the  individual  who  gets  a  piece  of  butter  put 
on  his  plate  wherever  he  happens  to  be,  and  the  question 


542  HENRY     B  A  I  R  D     F  A  V  I  L  L 

then  becomes :  Is  there  any  way  for  that  individual  to  tell 
whether  he  is  eating  butter  or  margarine?  Until  there  is  a 
way,  this  fight  has  got  to  go  on,  because  there  is  where  the 
substitution  occurs.  It  is  n't  in  the  kitchen,  grocery  store, 
or  factory;  it  occurs  when  it  is  put  on  the  plate.  It  sounds 
like  bigotry  to  say  that  margarine  must  not  be  colored. 
The  margarine  people  —  and  I  had  a  long  conference  the 
other  day  with  them,  a  long  and  pleasant,  but  an  abso- 
lutely divergent  conference  —  the  margarine  people  say  their 
product  must  be  colored,  they  can't  sell  it  otherwise.  We 
say  it  can't  be  colored  because  if  it  is  it  is  sold  for  butter, 
and  that  is  the  only  situation  to-day,  the  only  thing  worth 
talking  about.  Nevertheless,  the  public  has  not  been 
educated  to  look  at  it  from  the  standpoint  of  national 
salvation  at  all;  it  looks  at  it  from  the  mere  standpoint  of 
competition  between  butter  and  margarine,  between  the 
dairyman  and  the  packer,  when  it  is  a  question  that  is 
undermining  the  dairy  industry  by  making  it  meet  unfair 
competition  in  the  market,  and  when  our  industry  is 
undermined,  national  prosperity  is  jeopardized.  Now,  the 
question  is  as  big  as  that,  gentlemen.  Legislation  and 
public  opinion  have  n't  touched  the  essence  of  that  question, 
and  it  remains  for  you  in  every  possible  way  that  your 
influence  can  be  exerted,  to  see  that  public  opinion  is 
enlightened  on  the  subject.  It  is  not  merely  competition;  it 
is  the  question  of  the  unfair  burden  put  upon  the  dairy 
industry  by  misrepresentation ;  and  that  is  the  whole  thing. 
Then  there  is  one  other  thing  that  I  want  to  talk  to 
you  about,  very  seriously  indeed — it  was  suggested  to  you 
this  morning  by  Mr.  Hammond, —  I  want  to  say  that 
the  burden  and  the  great  struggle  before  the  dairy  industry 
to-day  is  the  health  question.  This  is  one  question  that  I 
feel  abundantly  competent  to  discuss.  I  have  taken  a 
great  interest  in  the  health  department  of  many  States 
myself.  I  am  not  going  to  discuss  it  very  much  except 
to  say  this :    That  the  agitation  with  reference  to  milk  and 


A(j  Rl  C  U  LT  U  R  IC     AND     DAIRYING  543 

milk  products  from  the  health  standpoint  of  health  officers 
and  by  aj^itators  of  one  kind  and  another,  and  women's 
clubs,  and  mothers  rearing  infants,  and  all  that,  has  been 
marshalled  into  a  great  big  influence  which  on  the  whole 
has  tended  to  check  and  restrain  the  dairy  industry.  Xow, 
gentlemen,  Mr.  Hammond  indicjitcd  that  to  me  this  morn- 
ing, and  the  logic  of  wlial  he  said  is  true.  He  said  the  public 
is  going  to  demand  clean  milk  at  a  safe  price,  and  he  cited 
tuberculosis  and  typhoid,  and  discussed  one  phase  and 
another,  and  he  is  right  about  it,  that  is,  where  the  public 
is  trained  the  public  is  moving  towards  a  closer  scrutiny 
as  to  quality  of  milk  with  reference  to  its  safety.  Their 
interest  in  it  as  to  chemical  cjuality  and  exact  food  value 
is  a  minor  matter.  What  the  public  is  concerned  about  is 
its  safety.  Now,  it  goes  without  saying,  that  in  a  great 
big  issue  —  where  a  very  large  percentage  of  the  agitators, 
with  absolutely  good  motive,  don't  know  one  thing  about 
the  subject  except  the  little  bit  of  tiny  knowledge  they  have 
on  the  subject  of  its  bacteria- — ^the  agitation  is  naturally  go- 
ing to  be  in  the  nature  of  a  crusade  against  the  industry-,  to 
a  large  extent.  Now,  as  deeply  as  I  realize  the  importance 
of  the  health  aspect  of  this  milk  question — feeling  as  deep- 
ly as  I  do  that  ultimately  it  has  got  to  be  solved  on  a  basis 
that  is  sound  and  in  the  interest  of  the  public — I  still  say 
that  it  is  of  the  utmost  importance  that  the  issues  incident 
to  the  milk  industry  shall  not  be  imposed  upon  from  with- 
out. The  ordinary  health  officer's  regulation  tends  to  be 
oppressive  because  it  is  not  intelligent.  The  average  attack 
made  upon  the  milk  situation  is,  as  a  rule,  exaggerated, 
because  it  is,"  as  a  rule,  not  comprehensive;  yet  that  is  the 
kind  of  regulation  there  will  be  unless  the  regulation  comes 
from  within,  and  that  is  the  thing  I  want  to  say  to  you  on 
that  subject.  The  thing  for  us  to  do  inside  of  the  dair^' 
industry  is  to  take  hold  of  this  question  of  safety  and  of 
quality  from  within  our  own  ranks,  and  see  to  it  that  it 
is  not  necessary  to  have  rules  imposed  upon  us  that  are 


544  HENRY     BAIRD     FA  V  ILL 

impossible  to  carry  out  and,  if  carried  out  off -hand  by  legis- 
lative enactments,  as  Mr.  Hammond  suggested  to-day, 
would  put  the  dairy  industry  out  of  business.  I  don't  say 
that  Mr.  Hammond  means  that  but  after  all  if  they  go  on 
enacting  on  the  whole  subject  the  way  it  is  thought  it  might 
be  done  it  would  absolutely  terminate  the  whole  dairy 
business.  The  thing  to  do  is  to  go  at  it  from  within,  and 
place  our  industry  above  the  assaults  of  those  who  know 
nothing  of  its  fundamentals. 

Now,  with  all  of  this  lot  of  things  I  have  said,  what  is 
the  remedy?  The  remedy  is  —  organization  in  the  milk 
business  more  than  any  other  business  in  the  world.  It 
does  n't  mean  moving  against  a  common  enemy.  If  there 
is  any  one  thing  organization  tends  toward,  it  is  self- 
improvement;   that  is  what  I  look  to  it  for. 

In  the  second  place,  we  have  got  to  do  something  with 
our  markets,  in  order  to  get  the  people  of  this  country  to 
realize  that  they  should  be  using  from  four  to  ten  times  as 
much  milk  products  as  they  do,  in  order  to  fully  satisfy 
their  physiological  needs  and  economic  needs, — from  four 
to  ten  times  as  much  should  be  used  as  is  used  to-day  in 
order  to  fully  justify  the  situation. 

And  to  accomplish  this,  I  want  to  say  to  you  this  whole 
question  becomes  a  matter  of  education;  it  is  a  matter  of 
presenting  right  information  on  the  part  of  every  man  that 
does  know  about  our  industry. 

You  know  what  the  agricultural  colleges  have  done, 
and  yet  there  comes  a  point  beyond  which  they  can  not  go ; 
there  is  an  abyss  that  they  don't  cross.  But  now  we  have 
the  county  agent;  he  attempts  to  cross  the  abyss;  he 
attempts  to  teach  of  agricultural  products;  and  he  goes 
right  out  and  shows  the  farmer  what  to  do,  and  he  is  the 
man  who  is  turning  the  trick.  You  have  no  idea  of  the 
difference  that  this  is  making,  and  the  responsiveness  of 
the  average  farmer  who  wants  to  know  what  to  do.  I  was 
talking  to  a  gentleman  this  morning,  and  he  asked,  "How 


AGRICULTURE     AND     DAIRYING  545 

would  you  go  about  getting  one  of  these  agents  ?    They  tell 

us  at  the  schools,  'if  you  will  send  your  milk  in  to  us  we 
will  assay  it  and  tell  you  how  much  butter  fat  is  in  it ' ;  the 
truth  is,  wc  don't  want  to  know,  and  yet  we  don't  know 
how  to  handle  our  dairy."  I  said  to  him,  "Are  you  and 
your  neighbors  standing  behind  your  community?  Then 
get  a  county  agent  that  actually  takes  the  farmer  by  the 
hand,  and  says,   'come  on;   this  is  the  way.'  " 

The  middleman  is  the  man  between  the  actual  producer 
and  the  market,  and  that  means  the  butter  people,  cheese 
people,  purebred  stock  people,  and  feed  people,  —  everybody 
who  is  involved  in  this  industry  in  any  way  should  take  hold 
of  the  subject,  and  each  and  every  one  of  the  things  we  have 
talked  about  should  be  directed  through  some  organiza- 
tion which  is  putting  forth  its  efforts  to  help  the  several 
interests.  It  is  the  only  solution.  I  have  come  here  to-day 
because  I  am  imbued  with  the  importance  of  the  whole 
situation,  because  there  are  involved  as  great  questions  as 
ever  will  come  before  the  people  of  this  country,  just  what 
we  are  talking  about  to-day,  and  I  hope  my  intensity  will 
lead  you  to  feel  there  is  something  to  be  intense  about. 


19 


III.     MISCELLANEOUS 


III.     MISCELLANEOUS 

Delivered  to  the   Graduatinj^    Class  of  vSt.   Jyukc's  Hospital   Training 
School  for   Nurses,   Juno   22,    1904. 

Printed,  The  Alumncc,  July,  1904. 

A   WAY   OF    LIFE 

FEW  vStudents  stepping  out  of  school  pass  into  their 
professional  work  with  so  easy  a  transition  as  do  the 
nurses  who  are  graduated  from  the  modern  schools. 

For  years  your  work  has  been  real  work,  differing  not 
at  all  in  subject  from  that  which  you  will  do  as  gradu- 
ates, and  in  method  differing  only  in  minor  detail.  You 
have  done  many  kinds  of  work;  borne  grave  degrees  of 
responsibility;  dealt  with  all  manner  of  perplexities.  It 
is  quite  possible  your  experience  has  been  more  varied 
than  all  5^our  subsequent  work  will  yield.  The. grade  of 
work  you  have  had  to  furnish  during  training  is  in  general 
the  highest  of  which  you  are  capable.  You  go  out  trained 
and,  presumably,  well  equipped.  For  work?  Yes,  thor- 
oughly equipped,  perhaps.     To  live?     That  is  not  so  clear. 

If  one  has  only  in  mind  sound  health,  good  habits,  and 
reasonably  intelligent  principles,  one  would  feel  very  safe 
in  saying  that  your  path  is  clear.  But  if  one  look  more 
closely  into  the  problem  of  life  and  regard  the  deep  perplex- 
ities of  your  relation  to  the  world,  one  can  not  have  more 
confidence  than  is  due  to  the  recognition  of  the  value  of  good 
ideals  and  the  beneficence  of  work.  Your  problem  is  as 
great  as  another's. 

It  is  probably  not  wise  to  start  out  with  the  conviction 
that  life  is  a  problem  with  the  terms  of  which  one  must 
struggle  constantly  and  intensely.  One  ought  to  have 
some  trust  in  the  true  direction  of  human  affairs,  and  repose 
in  a  great  measure  in  the  belief  that  good  woik  and  good 
intentions  3deld  good  results  and  make  a  creditable  life. 
But  of  these,  work  is  the  feature  of  safety.  Good  intentions 
may  be  coupled  wdth  the  most  hopeless  wreck.      Perhaps 

549 


550  HENRY     BAIRD     FA  V  ILL 

the  explanation  of  this  unhappy  fact  Hes  in  our  misconception 
of  intentions. 

Do  we  credit  a  careless  or  mischievous  child  with  much 
of  any  intentions,  good  or  bad  ?  Ought  we  not  to  have  in 
mind  a  certain  rational  quality  when  we  look  upon  good 
intentions  ?  Do  we  realize  that  it  is  not  at  all  the  same  thing 
simply  to  have  no  bad  intentions  and  to  have  really  good 
intent?  The  fact  is,  that  we  have  in  mind  the  negative 
quality,  this  absence  of  vicious  desire,  when  we  speak  so 
distrustingly  of  good  intentions.  Real  intentions  involve 
thought  and  vision  and  maturity. 

"When  I  was  a  child,  I  spoke  as  a  child,  understood  as 
a  child,  thought  as  a  child."  So  far,  perhaps,  not  bad,  but 
by  no  means  for  that  reason  of  necessity  good.  Good  living 
is  a  positive  process,  and  not  a  passive  drifting,  even  in 
placid  waters.  With  your  growth  into  maturity  comes 
obligation  to  think  and  see.  It  is  not  easy  to  think  inde- 
pendently when  one  is  of  the  mass  and  engaged  in  the  con- 
fusion of  world  affairs.  Still  harder  is  it  to  see  distinctly 
the  form  and  quality  of  single  acts  or  elements  of  human 
experience  when  overlapped  by  and  interwoven  with  all 
related  things. 

Multiplicity  of  items  and  complexity  of  structure  make 
the  detail  of  life  very  obscure,  and  this  lack  of  definition 
and  the  consequent  vagueness  of  our  conception  increases 
with  that  multiplied  function  that  we  call  civilization.  This 
is  true  of  all  affairs  of  society  and  especially  true  of  ethical 
questions.  Right  and  wrong,  instead  of  being  simple  and 
plain  in  the  network  of  life,  become  covered  up  by  the  over- 
lapping of  interests,  entangled  with  the  ideas  of  rights  and 
privileges  that  exist  as  a  matter  of  custom.  What  was  a 
simple  question  in  primitive  society  becomes  a  knotty  prob- 
lem in  modern  days ;  and  the  very  basis  of  decision  originally 
conclusive  may  be  repudiated  by  a  developed  ethical  code. 
Not  only  are  things  confused,  but  we  must  recognize  that 
there  is   nothing   unchangeably  fixed,    even  in   matters  of 


M  r  SC:  ELL  A  N  EOU  S  SSI 

right  find  wronjj;.  As  wc  ^row  in  experience  and  moral  in- 
sight, we  inevitably  modify  our  conceptions  of  morality. 

And  yet,  the  matter  is  not  hopeless  and  there  no  doubt 
is  a  way  to  live,  reasonably  clear  in  mind  and  heart.  Obvi- 
ously it  will  not  do  to  revert  to  some  conception  of  primi- 
tive society  and  try  to  live  on  that  hyj)othesis.  The  fruits 
of  human  experience  arc  the  property  of  the  race,  and  the 
use  of  its  lessons  the  obligations  of  the  race.  Whatever 
we  do  and  wherever  we  live,  we  can  not  ignore  them. 
We  find  ourselves,  then,  confronted  by  this  perplexity,  the 
necessity  to  think  and  act  intelligently  in  accordance  with 
our  light,  in  conditions  that  seem  to  hamper  individual 
action  and  cloud  one's  vision. 

Inevitably  the  question  comes  to  every  intelligent  mind, 
Why  do  I  live  so?  What  is  it  that  makes  me  a  factor  in 
this  more  or  less  badly  directed  even  if  not  purposeless 
stream  of  humanity?  And  even  while  answering  that  query 
more  or  less  satisfactorily,  the  further  query  comes,  need 
I  be  and  continue  so  unsatisfactorily  related? 

These  are  not  the  problems  of  youth,  nor  likely  to  be 
very  troublous  in  the  burst  of  early  enthusiasms.  Sooner 
or  later,  however,  they  will  arise,  and  to  me  it  seems  that 
sooner  is  better  than  later,  if  there  exist  a  solution  of  the 
difficulty. 

Obviously  it  is  not  for  any  of  us  to  "grasp  this  sorry 
scheme  of  things  entire"  and  "remold  it  nearer  to  the 
heart's  desire."  The  world  goes  on  in  its  ruthless  develop- 
ment, and  if  there  is  anything  to  be  accomplished  by  taking 
thought,  it  is  for  the  individual  in  his  voluntar^^  adjustment 
to  his  environment.  That  the  reflex  of  the  individual 
upon  the  mass  is  of  infinitesimal  power  is  usually  true; 
but  that  the  attitude  of  the  individual  toward  life  is 
potent  in  shaping  his  own  destiny,  or  at  least  in  deter- 
mining his  own  peace  of  mind,  one  can  not  question. 

The  primary  difficulty  in  approaching  this  matter  is 
with  the  individual.     No  progress  is  to  be  made  except  as 


552  HENRY    BAIRD     FAVILL 

the  expression  of  the  aggregate  weight  of  individual  aim  and 
effort.  Even  while  realizing  the  something  maladjusted  in 
life,-  the  mass  of  people  fail  to  recognize  what  is  awry,  and 
of  the  few  who  have  the  insight  to  discern  the  difficulty, 
still  but  a  fragmentary  few  have  the  confidence  and  poise 
to  grapple  with  it.  Yet,  it  seems  to  me  not  obscure  nor 
hopelessly  difficult,  though  one  must  admit  that  just  how 
to  do  is  not  always  clear. 

One  can  not  withdraw  from  the  rest  of  the  world  and, 
standing  in  contemplation  of  the  scene,  rejoice  in  the  fact 
that  he  is  fortunately  independent.  One  must  go  on  in  the 
stream,  fulfilling  his  obligations  as  they  appear.  The  ques- 
tion then  becomes,  Can  one  be  closely  surrounded  without 
being  entangled  in  the  network  of  affairs  ?  Is  one  an  integral 
part  of  the  plan,  a  thread  in  the  weave,  or  is  the  contact 
voluntary  and  intelligent,  more  or  less  to  be  determined  by 
choice?  If  we  are  bees,  clearly  we  are  the  former.  If  we 
are  evolving  another  type  of  living,  we  may  be  the  latter. 
But,  if  the  latter,  if  we  are  to  have  an  independence  of  being, 
how  is  it  to  be  accomplished  ?  Clearly  there  are  limitations 
upon  this  possibility.  But,  is  an  approach  to  it  desirable? 
Is  the  effort  feasible?  Assuming,  as  I  do  assume,  that  a 
personal  freedom  of  some  sort  is  the  ideal,  the  various  con- 
siderations involved  in  this  struggle  become  of  paramount 
importance.  I  say  struggle  advisedly,  for  no  matter  how 
gentle  and  quietly  the  end  may  be  achieved,  the  process  is 
incessantly  more  or  less  strenuous. 

As  we  regard  life  to-day,  we  owe  an  obligation  to  our 
fellows.  We  have  duties  and  responsibilities  to  society. 
To  live  in  the  world  and  shirk  these  is  not,  under  our  best 
conceptions,  moral.  So  far  as  these  exist  we  are  not,  can  not 
be  independent.  They  constitute,  it  is  true,  much  of  the 
burden  of  life  and  the  more  imperative  as  we  grow  in  ethical 
perceptions.  As  citizens  or  'fathers  or  m.others  or  nurses, 
we  find  before  us  always  duties  unavoidable  and  more  or 
less  acceptable  according  to  our  strength.     It  is  preposterous 


M  I  S  C  E  L  T.  A  N  E  O  U  S  553 

to  suj?gcst  lli.'it  we  ('.'in  ignore  l.licni  anfl  Uuis  achieve 
independence.  In  fact,  we  are  prone  to  regard  our  duties 
as  the  inexorable  law  that  enslaves  us;  to  become  the 
helpless  drones  in  our  various  tasks. 

We  look  about  us  as  the  years  go  on  and  realize  that 
every  day  adds  to  our  points  of  contact  with  the  world,  and 
that  in  consequence  we  establish  daily  new  relations  that 
bind  us  more  or  less. 

You  will  agree  that  the  labor  of  living  increases  con- 
stantly as  the  resources  of  the  world  increase,  and  the 
means  of  comfort  and  indulgence  multiply;  as  the  com- 
munity develops  from  the  primitive  and  provincial  into  the 
cosmopolitan ;  as  the  knowledge  of  material  possessions  and 
so-called  civilized  ways  permeates  the  people  and  pene- 
trates into  the  more  isolated  parts.  As  the  reciprocal  func- 
tions of  individuals  and  classes  develop,  life  becomes  more 
difficult,  more  strained,  more  selfish.  Labor-saving  devices 
beget  new  labors.  Facilities  for  comfort  induce  struggle 
to  acquire  them.  We  see  ourselves  of  the  machine  and 
bound  to  our  part. 

From  this  point  of  view  the  problem  becomes  more  diffi- 
cult the  longer  we  live.  But  are  we  right  about  this?  Is  it 
our  duty  to  society  that  enslaves  us.  Is  it  dependence  of 
society  upon  our  contributions,  no  matter  how  valuable  or 
important,  that  is  such  an  irresistible  pressure'  Is  it  not 
rather  some  dependence  that  we  feel  upon  society  that 
makes  us  into  more  or  less  automatic  toilers  ?  Toilers  often 
overworked  and  too  often  without  joy  in  our  work?  Do 
we  feel  as  a  rule  that  individual  independence  that  makes 
for  peace  of  mind  and  unhampered  work?  Few  there  are 
who  have  not  in  mind  some  later  day  when  by  hook  or  crook 
life  will  be  more  simple  and  relieved  of  its  perplexities. 
Yet  be^^ond  doubt  it  rarety  becomes  less  complex,  and  in 
fact  it  is  only  by  adopting  some  plan  for  daily  use  that  much 
improvement  can  be  wrought. 

If  we  analyze  our  habits   of  body  and   mind  we  are 


554  HENRY     BAIRD     FA  V  ILL 

impressed  by  the  fact  that  we  are  all  run  into  one  mold. 
We  eat  and  sleep  and  work  and  play  and  talk  and  think  in 
ways  so  similar  one  to  another  as  to  make  a  general  uni- 
formity/ Of  course  from  one  point  of  view  this  represents 
the  working  out  of  a  best  way  through  experience,  but  from 
another  point  of  view  it  is  essentially  imitative.  We  do  all 
this  not  because  we  realize  that  it  is  the  best  way,  but 
because  other  people  do  so.  And  here  lies  the  gist  of  the 
whole  matter. 

Without  discrimination  as  to  our  individual  needs  we 
assume  that  we  must  do  the  conventional  thing,  rapidly 
create  habits  accordingly,  and  finally  establish  as  necessities, 
all  manner  of  things  which  bear  upon  our  physical  and  men- 
tal life,  which  are  in  fact  nothing  more  than  accustomed 
factors  and  bear  no  relation  to  our  real  needs. 

So  far  as  they  become  habits  they  dominate  us  largely, 
but  after  all,  the  real  tyranny  is  in  the  adherence  to  that 
customary  method  that  we  call  fashion. 

The  need  for  food  at  certain  times  is  habit.  The  type 
of  food  that  we  demand  for  our  satisfaction  is  determined 
by  fashion.  So  with  clothes,  so  with  mental  food,  so  with 
life  in  general.  We  have  certain  elemental  needs;  upon 
these  needs  we  have  erected  a  huge  and  complicated  struc- 
ture of  wants,  and  these  wants  representing  for  the  most  part 
not  our  spontaneous  want,  but  our  imitation  of  the  ways 
of  others  that  have  again  in  them  no  relation  to  real  needs. 

Not  only  is  this  true  in  physical  and  material  things. 
It  gives  color  to  our  mental  operations,  to  our  conception 
of  culture  and  education,  and  it  dominates,  to  a  crippling 
degree,  our  moral  standards  and  judgments.  Not  only 
must  we  know  certain  things,  read  so  and  so,  have  such  and 
such  accomplishments,  but  we  must  take  the  customary 
attitude  toward  moral  questions,  with  no  weighing  of  them 
upon  their  merits  for  ourselves,  but  because  society  has 
gotten  into  that  rut,  and  so  far  as  social  edict  is  our  law,  has 
so  decreed. 


M  T  S  r  ET.  T,  A  N  EO  TI  S  555 

All  of  tliis  T  !iTcrc!ly  sketch  and  siij^j^cst,  for  the  purpose  of 
dircctinjjj  your  attention  to  the  deiK'nclenee  that  we  permit 
ourselves  to  establish  u])on  others,  and  to  contrast  it  with 
freedom  of  individual  action  and  judgment.  The  result  of 
this  is,  that  in  material  ways  we  become  enslaved  by  things. 
In  intellectual  ways  we  become  fettered  by  opinion. 

In  either  event  we  find  ourselves  under  a  pressure  that 
is  a  burden.  We  struggle  madly  to  provide  ourselves  with 
things.  We  live  distortedly  to  ensure  for  ourselves  har- 
monious opinion.  But  again  I  repeat:  It  is  not  what  we 
do  for  society  that  makes  our  burdens.  It  is  the  demands 
that  we  allow  ourselves  to  make  upon  society;  the  wants 
we  permit  to  grow  upon  us  that  keep  us  chained. 

And  now  I  am  prepared  to  offer  an  answer  to  the  query 
I  propounded  in  the  beginning,  "Need  I  be  and  continue 
so  unsatisfactorily  related?"  To  me  it  seems  beyond  all 
question  that  one  need  not.  I  am  not  of  a  mind  to  advise 
a  radical  and  obtrusive  revolt  against  the  conventions  of  life. 
Few  are  strong  enough  to  attempt  it.  None  perhaps  are 
wise  enough  to  justify  it. 

/  plead  only  for  a  quiet  withdrawing,  so  far  as  one's  inner 
and  personal  life  is  concerned,  within  the  circle  of  one's  indi- 
viduality. I  believe  it  is  wise  to  realize  that  one's  needs  are 
few;  to  make  one's  wants  simple;  to  regard  possessions  as  a 
burden,  not  a  boon;  to  feel  that  the  sacrifice  of  peace  and  self- 
respect  to  fashion  is  ignoble;  to  find  repose  and  reward  in  work 
well  done;  and  above  all  to  recognize  that,  inasmuch  as  the  only 
place  of  judgment  of  final  value  is  one's  inner  consciousness, 
to  cast  one's  life  according  to  outside  influence  is  to  come  to 
inevitable  discord  with  one's  deeper  nature. 

And  now,  young  ladies  of  the  graduating  class,  in  pre- 
senting to  you  this  simple  idea,  I  am  aware  that  it  has  no 
application  to  3^ou  more  than  to  other  people  of  your  age 
and  experience.  I  think  perhaps  I  say  it  to  a^ou  with  the 
more  earnestness  because  of  a  realizing  sense  which  I  have, 
that  you  have  started  out  on  a  career  of  promise  both  as  to 


556  HENRY     BAIRDFAVILL 

personal  happiness  and  general  usefulness.  I  have,  hence, 
a  deep,  underlying  feeling  that  anything  which  could  con- 
tribute to  the  rounding  out  of  personal  character,  even  by 
so  slight  a  suggestion  as  this,  I  am  anxious  to  contribute. 
I  suspect  also  that  I  have  a  slight  feeling  of  anxiety  because 
of  special  temptations  which  I  know  you  are  destined  to 
encounter. 

Your  work  carries  you  away  from  the  simplicity  of  hos- 
pital life  and  routine  into  all  manner  of  external  worldly 
conditions.  By  no  means  always,  but  frequently  enough, 
your  path  lies  in  association  with  the  extreme  luxuries  of 
life.  Familiarity  and  custom  breed  habit,  and  habits  are 
insidious  and  tenacious.  The  only  safeguard  against 
dropping  into  the  things  which  do  not  become  you  and 
which  you  can  neither  afford  nor  profit  by,  is  eternal  vigi- 
lance. I  urge  you  to  maintain  for  yourself  a  rigid  dis- 
cipline and  circumspection  as  to  personal  habits,  discrimi- 
nating intelligently  between  needs  and  wants,  to  the  end  that 
you  become  not  only  personally  self-possessed,  but,  toward 
the  public,  quiet  and  impressive  examples  of  wise  living. 

And  now  in  parting  from  you,  the  pleasure  of  bidding 
you  Godspeed  is  qualified  by  the  pain  of  having  you  leave 
our  family  walk. 

The  comfort  in  this  lies  in  the  fact  that,  although  you  do 
go  hence,  most  of  you,  we  hope,  will  periodically  renew 
your  associations  with  us  in  various  circumstances,  and 
that  we  shall  move  on  in  paths  of  common  usefulness 
and  mutual  support. 


M  I  S  C  I-:  L  L  A  N  E  O  U  S  557 


From  a  Personal  IvclLcr,  Wril,k-n  March  28,  1905. 

SMOKINO 

IT  naturally  occurs  to  a  boy  as  a  r|ucstion,  Why  do  our 
ciders  who  have  habits  decry  them  to  their  youngers  as 
pernicious  ?  Therein  is  the  epitome  of  all  liuman  frailty. 
Every  man  sees  himself  the  victim  of  more  or  less  domi- 
nating habits  which  he  would  give  the  world  to  be  rid  of 
and  which  he  can  be  rid  of  only  by  great  struggle.  The 
difference  between  getting  rid  of  a  habit  and  never  hav- 
ing had  it  is  world  wide.  Of  course,  this  applies  not  only 
to  tobacco,  it  applies  to  all  extravagant  and  deteriorating 
habits. 

If  one  could  only  realize  in  youth  the  great  power  of 
habit,  and  this  applies  just  as  much  to  good  habits  as  to 
bad  ones,  he  would  invoke  his  intelligence  on  this  subject 
much  more  deeply. 

The  man  who  grows  old  wisely  puts  in  a  large  part  of 
his  time  in  undoing  the  habits  of  his  youth  or  building  up 
habits  which  he  should  have  built  up  in  his  youth. 

So  far  as  this  tobacco  question  is  concerned,  I  am  une- 
quivocal in  the  following  opinion: 

The  individuals  who  are  distinctly  benefited  physically, 
morally,  or  mentally  are  so  few  as  to  be  practically  none. 
The  individuals  who  are  seriousl}/-  damaged  physically, 
morally,  and  mentally  thereby  are  myriads.  Between 
these  two  extremes,  is  the  great  army  of  tobacco  users, 
none  of  whom  are  benefited  and  all  of  whom  are  verging 
more  or  less  closely  upon  injury. 

The  basis  of  the  habit  is  essentially  social.  The  super- 
structure is  a  craving  of  the  nervous  system  for  a  narcotic. 
A  boy  begins  to  smoke  for  imitative  reasons.  He  lets 
the  habit  grow  upon  him  for  social  reasons.  He  becomes 
dominated  by  it  for  narcotic  reasons.     Tobacco  is  a  strong 


558  HENRY     BAIRD     FAVILL 

narcotic,  ver}^  damaging  to  the  nervous  system,  more  or  less 
according  to  the  individual  and  according  to  the  intensity 
of  the  practice. 

There  is  no  doubt  that  tobacco  has  a  strong  influence 
in  the  deteriorations  involved  in  the  heart,  kidneys,  and 
brain.  That  it  does  not  more  often  obviously  produce 
disaster  is  probably  due  to  the  fact  that  it  is  abandoned 
before  the  crash  comes.  That  comparatively  few  people 
are  badly  hurt  by  it,  is  a  common  observation.  This  is  not 
true.  There  are  few  people  who  are  not  more  or  less  hurt 
by  it  and  the  reason  it  is  not  more  apparent  is  because  the 
effect  is  so  indirect  and  insidious. 

I  do  not  hesitate  to  say  that  I  would  strongly  urge 
any  boy  never  to  begin  the  use  of  tobacco.  To  postpone 
it  to  the  age  of  twenty-one,  or  thirty-one,  or  forty-one  does 
not  help  it  materially.  I  would  just  as  soon  say,  do  not 
begin  to  use  opium  until  you  are  of  mature  years.  Not 
that  tobacco  is  as  harmful  as  opium,  but  the  question  of 
beginning  at  some  late  date  is  about  the  same  in  principle. 

There  are  very  intelligent  medical  men  who  will  not 
accept  this  extreme  opinion.  I  am,  however,  quite  con- 
vinced of  its  truth. 

The  fact  that  one  does  not  urge  every  man  to  entirely 
forswear  tobacco  is  quite  like  other  facts  of  a  non-meddle- 
some nature.  However,  as  a  rule  they  are  better  off  without 
tobacco. 

If  they  do  not  choose  to  stop  it,  that  is  clearly  their  affair. 
A  boy,  however,  is  entitled  to  perfectly  definite  and  candid 
advice.  I,  therefore,  without  hesitation  ask  you  to  pass 
this  on. 


M  I  S  C  E  L  T.  A  N  K  O  TJ  S  559 


Delivered  Id  Hie  nij;li  Selidol    I'npils  of  llie  I'nincis  W.  I'.'irkcr  School, 
Murch  22,   1907.* 

THE  PROFESSION  OP  MEDICINE  AS  A  VOCATION 

UNDER  the  illumination  of  this  school  to-day,  I  am 
conscious  of  having  a  distinct  feeling  of  somethinj< 
missed  when  I  was  of  school  age.  I  do  not  think  I 
ever  felt  it  so  clearly  before. 

I  am  an  old  teacher,  accustomed  to  lecturing  to  men  and 
women  from  platforms  without  embarrassment  —  I  should 
be  ashamed,  in  this  school,  to  use  the  term  embarrassment, 
as  the  term  does  not  fit  the  situation,  —  but  still  I  am  a  little 
at  sea  as  to  what  to  say  on  this  subject  to-day,  because  of 
the  fact  that,  technically,  I  am  talking  about  something 
that  you  do  not  know  much  about,  although  generally  I 
am  talking  about  things  which  you  know  as  much  about 
as  I  do.  So  it  is  difficult  to  know  what  to  say  without 
getting  into  territory  that  is  useless  to  you. 

The  thought  of  a  vocation,  as  to  what  one  is  going  to  do 
in  life,  does  not  strike  in  at  a  very  early  age.  But  although 
you  may  not  weigh  the  matter  very  seriously,  yet  every- 
body, from  the  time  of  small  childhood,  has  ideas  and 
aspirations  in  various  directions  based  upon  taste  —  some- 
times very  unaccountable  taste. 

I  remember  clearly  my  determination  about  a  vocation 
up  to  quite  an  age  —  and  I  still  retain  the  taste  that  deter- 
mined me  that  I  was  going  to  be  a  blacksmith.  The  reason 
was  because  I  wanted  to  shoe  horses.  After  that  I  was 
determined  that  it  was  in  my  power  to  emulate  a  colored 
friend  and  achieve  a  brilliant  career  as  a  coachman.  Now. 
to  a  large  extent,  I  have  never  lost  either  of  those  tastes. 
If  I  had  to  go  into  any  manual  trade  it  would  be  blacksmith- 
ing;  and  the  one  manual  work  that  I  could  do  would  be 

*  The  stenographic  report  of  this  paper  was  imperfect,  and  I  have  done 
the  small  amount  of  editing  necessary  to  make  it  readable. — J.  F. 


566  HENRY     BAIRD     FAVILL 

taking  care  of  horses  and  all  that  pertains  to  them.  That 
is  something  that  was  undoubtedly  born  in  me.  I  am  very 
certain  that  the  taste  for  being  a  physician  was  not  born 
in  me.  I  remember  first  being  mixed  up  with  those  inter- 
ests when  going  with  my  father  among  wounded  men, 
but  it  was  not  anything  that  I  was  interested  in  or  cared 
about. 

And  so  it  is.  As  we  go  along  in  life  we  come  up  to  a 
point  of  decision  beyond  youthful  fancies,  and  early  notions. 
Of  course  there  are  exceptions,  as,  for  example,  many  boys 
grow  up  with  a  clear  idea  of  being  mechanics.  But,  after 
all,  it  is  not  the  rule,  it  is  the  exception  when  any  boy  or  girl 
grows  up  with  any  clear  idea  of  what  he  or  she  is  going  to  do. 

It  can  not  always  be  a  matter  of  taste  or  fancy.  Various 
conditions  come  in  to  be  determining.  The  questions  must 
be  asked:  What  can  I  afford  to  do?  What  education  can 
I  afford  to  have?  What  are  the  circumstances?  What  are 
the  traditions  of  my  family?  Is  it  my  duty  to  follow  busi- 
ness? What  is  the  tradition  of  my. family  as  to  the  profes- 
sions ?  Can  I  afford  to  put  in  the  time  necessary  to  acquire 
a  professional  education?  All  these  questions  come  in,  so 
that  it  is  not  always  a  matter  of  free  choice. 

But  suppose  we  had  free  choice  so  that  we  could  choose 
what  we  would,  what  would  we  do,  and  how  make  the 
choice?  Well,  a  certain  proportion  of  people  would  inevit- 
ably choose  to  be  professional  people  and  they  would  scatter 
themselves  variously,  according  to  their  bringing  up,  among 
lawyers,  or  physicians,  or  ministers. 

In  the  beginning,  almost  any  boy  or  girl  chooses  a  profes- 
sion without  any  clear  conception  of  what  that  profession 
is,  what  it  involves,  or  what  he  wants  himself.  He  may 
choose  it  because  he  thinks  it  is,  as  one  might  say,  respect- 
able. But,  with  all  of  that  lack  of  distinct  knowledge  of 
what  he  intends  to  do,  as  a  rule,  a  young  boy  or  girl  has 
ideals — ideals  which  are  very  well  marked,  high  ideals,  ro- 
mantic ideals   sometimes,  miscalculating  ideals  sometimes 


M  J  SC  IC  [.LAN  I-:  ()  li  S  561 

—  and  there  is  no  other  aj^e  at  which  so  many  people  are 
prompted  to  hiteh  their  wagons  to  stars. 

Now  I  do  not  mean  to  say  that  J  think  people's  ideals 
fall  off  as  they  grow  older,  they  simply  alter  very  mueh. 
Beyond  question,  many  people  do  lose  their  ideals  in  prac- 
tieal  life  as  they  eome  into  the  disaj>pointments  and  anom- 
alies of  life,  and  as  they  come  to  know  what  the  affairs  of 
the  world  involve.  But,  of  course,  that  is  all  very  wrong. 
Just  becau.se  you  are  disappointed;  just  because  a  thing  is  not 
what  you  thought  and  does  not  appear  as  you  thought  it 
was  going  to  appear;  because  the  majority  of  people  you 
come  in  contact  with  are  not  what  you  think  they  ought 
to  be  or  conceived  that  they  would  be;  all  this  is  no  reason 
why  your  ideals  should  be  lost. 

As  a  matter  of  fact,  the  evolution  should  be  a  creation  of 
ideals  rather  than  a  loss,  and  those  who  have  effect  in  the 
world  know  that  the  progress  of  ideals  should  be  into  a  more 
and  more,  rather  than  into  a  less,  exacting  sphere,  and 
should  be  toward  putting  into  other  lives  hopes  and  aspira- 
tions and  ideals  which  are  dominant  and  strong  and  manly. 

As  you  go  on  into  life  and  affairs  open  up  before  you, 
the  aspirations  remain,  more  or  less,  but  they  may  seem  to 
wane  because  they  go  through  changes.  What  happens  to 
you  becomes  of  not  so  much  consequence,  and  your  hopes 
become  less  because  it  becomes  perfectly  clear,  as  time 
goes  on,  that  they  are  going  to  be  disappointed.  There  are 
quantities  of  things  that  you  thought  would  be  so  and  so 
which  are  not  so  and  so.  This  is  a  disappointing  fact  pro- 
viding you  have  permitted  yourself  to  become  too  self- 
centered  and  intent  upon  the  form  of  things. 

Aspirations  and  hopes  may  fail,  but  they  should  be 
replaced,  and  under  strong  and  satisfactory  conditions  they 
are  replaced,  by  convictions  —  b}-  their  gradual  transforma- 
tion into  firmly  rooted  beliefs  as  to  what  is  so  and  so,  what 
is  worth  while,  what  is  to  do.  What  can  be  done  involves 
not  only  a  belief  in  your  ideals  but  also  a  dominant  impulse 


562  HENRY     B  A  I  R  D     F  A  V  I  L  L 

within  you  that  would  lead  you  to  follow  that  belief  to  the 
end,  no  matter  what  it  might  be.  That  is  a  conviction.  A 
conviction  is  different  from  a  belief.  A  conviction  ought  to 
be  the  fruit  of  hope  and  aspiration;  and,  as  a  matter  of  fact, 
this  is  so. 

Gradually,  as  you  go  through  the  experiences  of  life  and 
find  that  it  is  not  what  you  thought,  that  it  is  bitter,  that  it 
is  disappointing,  little  by  little  you  replace  the  thing  that 
you  wanted  by  the  thing  that  you  have  proved,  and  you  find 
that  it  is  just  as  good  and  on  the  whole  better. 

When  it  comes  to  the  selection  of  the  practice  of  medi- 
cine as  a  vocation  it  does  not  become  as  a  certainty  a  mat- 
ter of  a  clear  ideal.  I  suppose  that  every  individual  who 
chooses  to  be  a  physician  chooses  that  calling  for  some 
different  reason.  I  am  not  clear  as  to  what  actuated  me. 
Whatever  actuated  me,  I  have  received  many  a  jolt  since 
then,  and  yet  I  can  not  say  that  I  have  ever  seen  the  time 
when  I  have  regretted  the  choice.  I  think  that  is  a  fair 
statement  to  make.  Still,  it  is  not  what  I  thought  it  would 
be,  and  if  I  had  had  the  least  idea  of  what  it  involved,  at 
the  age  of  nineteen  when  I  made  my  choice,  I  never  should 
have  considered  doing  it  by  any  possibility,  because  I 
should  not  have  considered  myself  adequate.  Perhaps  it 
is  fortunate  not  to  know,  because  to  know  what  it  would 
mean,  without  being  able  to  know  what  one  could  person- 
ally do  about  it,  would  be  a  very  discouraging  thing. 

However,  one  goes  into  that  profession  for  one  reason 
or  another,  and  by  and  by,  after  his  studies  are  over,  after 
his  technical  education  is  over,  he  finds  that  instead  of  be- 
ing what  he  thought  he  was  going  to  be  —  a  minister  to  the 
sick,  a  student  going  on  in  a  quiet  path  of  usefulness  —  he 
is  plunged  into  a  struggle  for  life,  a  struggle  that  partakes 
in  many  respects  of  business. 

If  you  know  anything  about  doctors,  you  know  that 
they  would  refute  the  charge  that  they  are  in  business, 
not  because  of  a  distaste  for   business,   but   because   the 


M  I  S  C:  K  F.  I.  A  N  K  O  U  S  563 

profcssion.'il  st.aiul.'Lnl  of  success  is  not  profit.  There  arc 
many  respects  in  which  a  profession  (mght  not  to  he  a  husi- 
ness,  but  there  is  no  reason  why  they  cannot  come  together 
on  some  basis  and  make  all  business  a  profession.  If  there 
are  businesses  and  professions  which  hold  themselves  apart 
as  being  different,  then  that  difference  should  be  obliterated 
by  bringing  business  into  the  category  of  a  profession. 

You  see  this  (jucstion  of  business,  the  material  aspect 
of  the  thing,  is  very  important.  We  hear  an  expression 
used  in  the  world  —  and  I  presume  you  have  heard  it,  you 
know  the  general  terms  —  ethics  and  ethical  conduct.  We 
mean  by  that  the  highest  measure  and  standard  of  judg- 
ment as  to  right  and  wrong  —  the  moral  quality  of  our 
actions.  A  great  many  things  take  place  in  business  that 
are  patent  questions  and  they  are  excused  by  the  unthinking 
(and  the  unthinking  includes  a  great  majority  of  people), 
with  the  statement  that  these  are  business  ethics  —  as 
though  it  was  possible  to  have  business  ethics  apart  from 
ethics!  To  combine  with  others  against  your  neighbor; 
to  do  this  thing  or  that  thing  that  injures;  to  be  this  thing 
or  that  thing  that  is  disappointing,  that  is  not  square  or 
true ;  this  is  excused  on  the  ground  that  it  is  business  ethics. 
Now  let  us  from  this  time  purge  from  our  minds  any  ques- 
tion of  business  ethics  that  can  be  distinguished  from  ethics. 
I  want  to  say  this  in  passing. 

We  of  the  medical  profession  come  right  up  against  this 
business  proposition  because  of  our  wares,  our  professional 
abilit}^  whatever  that  may  be.  We  have  for  sale  our  time, 
our  efforts,  our  intelligence,  the  fruits  of  our  study;  they 
are  for  sale  and  you  and  yours  buy  them.  Whether  they 
are  worth  anything  or  not  is  open  to  question,  and  you 
judge  them  in  very  much  the  same  way  that  3^ou  judge 
anything  else,  and  consequently  we  get  a  business  aspect. 

It  would  be  much  more  in  keeping  with  the  spirit  of  the 
physician's  life  if  he  had  no  wares  to  sell;  if  his  wares  were 
poured  out  freely.     It  would  be  a  question  what  would  be 


564  HENRY     BAIRD     FAVILL 

the  best  way  to  do  that,  but  after  all  it  would  be  a  comfort 
to  physicians  if  they  were  not  obliged  to  have  any  business 
aspect  in  their  lives. 

However,  we  have  it,  and  the  question  is,  then  and  there, 
what  shall  be  done  about  the  physician's  work  on  that 
basis?  That  brings  up  the  question  of  money.  It  has  its 
place,  it  has  its  right.  It  is  right  that  we  should  earn  money. 
It  is  right  that  we  should  have  money  to  provide  for  our 
needs.  It  is  right  that  we  should  save  money  against  our 
inability  to  work,  and  all  that  sort  of  thing.  And  yet  it  is 
very  easy,  of  course,  to  be  overpowered  by  the  desire  for 
money  and  the  desire  for  the  things  that  money  brings. 
It  is  just  as  easy  for  a  doctor  to  be  overpowered  with  this 
sort  of  thing  as  for  anybody  else.  The  prospects  are  less, 
but  the  temptation  is  the  same. 

It  has  to  be  said  in  fact  that  the  need  for  money  is,  with 
the  doctor  as  with  anybody  else,  one  of  the  most  stimulat- 
ing factors  in  his  life.  It  is  true  that  poor  men,  men  who 
start  in  poverty,  as  a  rule  do  better  in  the  practice  of  medi- 
cine than  those  who  start  with  plenty.  And  of  course  that 
is  pure  human  nature.  The  necessity  to  do  is  a  greater 
incentive  than  the  taste  to  do.  As  a  consequence,  we  work 
harder  under  necessity  than  for  some  moral  stimulus  that 
we  might  have. 

So  that  consideration  again  brings  this  question  into  a 
place  that  is  important.  And  yet  nobody  would  think  of 
going  into  the  profession  of  medicine  for  the  sake  of  accumu- 
lating money,  although  that  really  happens  to  us  now  and 
then.  Nobody  would  think  of  going  into  it  for  the  sake  of 
accumulating  money,  and  nobody  would  think  of  going  into 
stock  jobbing  for  any  other  reason.  Perhaps  it  is  unfair 
to  put  it  so  strongly,  but  that  is,  after  all,  the  fact.  So  in 
medicine  money  must  be  the  least  consideration.  The  fact 
then  becomes  this:  Outside  of  the  proper  place  that 
money  has  in  all  the  affairs  of  life,  the  more  it  enters  into 
the  proposition  of  being  a  doctor,  the  worse  off  a  man  is  as 


M  I  S  f   K  L  L  A  N  E  O  U  S  565 

a  doctor,  and  so  it  should  lie  put  aside  as  outside  of  the  cate- 
gory—  and  that  leaves  il. 

If  the  practice  of  medicine  is  not  business,  what  is  it? 
I  am  not  going  to  speak  of  or  go  into  the  scientific  possi- 
bilities in  medicine  for  the  physician ;  that  is  not  the  point. 
What  is  the  service  that  the  physician  renders  to  the  com- 
munity? That  is  the  real  question,  not  what  service  can 
he  render  to  himself.  What  can  he  do  for  his  fellowman? 
Those  of  you  who  have  had  any  experience  with  the  physi- 
cian will  have  various  ideas  about  that,  but  on  the  average 
you  will  agree  that  his  first  function  is  to  alleviate  suffer- 
ing. It  may  be  pain,  it  may  be  fault,  it  may  be  perplex- 
ity— whatever  it  may  be,  the  first  thing  that  a  physician 
does,  beyond  all  things,  is  to  alleviate  somebody's  distress 
in  some  direction.  It  really  sums  up  the  whole  function  of 
the  physician  in  the  world.  Whether  it  is  the  alleviation 
of  a  physicial  difficulty  involving  scientific  knowledge,  or 
whether  it  is  a  mental  difficulty  involving  perplexity  about 
the  conditions  of  life,  or  whether  it  is  a  broad  question 
of  the  development  of  children,  or  whatever  it  may  be, 
the  problems  of  life  as  they  occur  in  the  household  are  the 
problems  which  come  into  the  hands  of  the  physician. 

The  question  then  comes,  Why  into  the  hands  of  the 
physician,  why  not  into  the  hands  of  the  next  door  neighbor, 
or  the  lawyer,  or  the  preacher?  As  a  matter  of  fact,  those 
various  elements  in  the  community  do  come  into  this  dis- 
cussion to  a  large  extent  and  they  do  help  in  this  alleviation 
of  trouble,  but,  as  we  are  organized,  it  is  true  that  the  physi- 
cian is  oftener  called  upon  to  give  his  advice  upon  proposi- 
tions involving  the  concerns  of  the  family  life  than  any 
other  man.  Probably  because  his  knowledge  of  the  phys- 
ical forces  of  the  body  enables  him  to  judge  of  physical 
questions  as  an  expert ;  probably  because  in  connection  with 
his  studies  his  view  of  the  mental  questions  of  life  becomes 
broader  and  more  nearly  that  of  an  expert  than  that  of  any 
other  man  in  the  community;    and  partly  because  of  his 


566  HENRY     BAIRD     FAVILL 

wide  experience  with  people  of  all  kinds  —  the  highest  and 
lowest,  the  richest  and  poorest,  the  best  and  the  worst  — 
the  real  difficulties  of  life  are  brought  to  him. 

Every  gradation  of  society,  if  he  is  wise  and  capable 
of  growth,  gives  him  in  the  end  a  comprehensive  view  of 
humanity  such  as  I  believe  no  other  individual  in  the  com- 
munity has  an  opportunity  to  get,  and,  consequently,  such 
as  no  other  individual  really  does  have.  That  is  why  the 
physician  is  led  into  all  this,  not  because  he  knows  so  much 
more  but  because  his  type  of  life  gives  him  this  intimate 
association  with  every  kind  of  person,  and  gives  him  the 
broadest  sympathy,  the  keenest  judgment,  and  the  largest 
fund  of  resources  as  to  what  to  do  under  given  circum- 
stances. And  it  is  true  that  the  physician  consequently 
becomes  the  adviser  of  the  particular  part  of  the  community 
in  which  he  moves,  and  he  grows  broader,  and  finally  some- 
times comes  to  be  very  broad. 

There  is  another  point  to  all  this  —  another  side.  We 
say  people  submit  their  troubles  to  the  physician.  Why? 
Because  they  are  unequal  to  therti;  because  the  complexity 
of  life  is  so  great  and  the  large  majority  of  people  are  not 
equal  to  handling  it. 

All  the  trouble  of  the  world  originates  and  has  to  do 
with  the  family.  Everything  that  you  can  conceive  in  the 
way  of  human  suffering  has  its  unit  of  activity,  and  its  unit 
of  suffering,  in  the  family,  and  the  consequence  is  that  the 
physician  is  the  individual  who  is  most  called  upon,  out- 
side of  the  family,  to  participate  in  those  matters.  What- 
ever it  may  be,  the  physician  is  the  individual  who  is  called 
in  for  counsel  and  for  help. 

I  am  trying  to  show  you  that  this  question  of  being  a  doc- 
tor is  not  a  mere  matter  of  writing  a  prescription  and  going 
on.  This  being  a  doctor,  if  you  are  anything,  is  the  being 
willing  to  be  the  confidential  recipient  of  every  human 
trouble,  and  the  adviser,  so  far  as  in  you  lies,  of  every  in- 
dividual who  has  trouble.     Of  all  the  callings  now  known  to 


M  T  S  C  E  L  L  A  N  FC  O  U  S  567 

me,  there  is  none  which  has  so  much  possibility  for  hij<h 
un.selfish  minislralion  l,o  human  woe  as  the  calHn^  of  the 
physician. 

And,  yel,  I  intend  to  call  your  attention  to  the  fact  that 
it  is  perfectly  possible  to  ruin  it  by  a  loss  of  ideals,  by  a 
sinking  of  standards,  by  a  .selfishness  of  purpose,  by  making 
it  a  mercenary  matter,  by  making  it  a  means  of  self-aggran- 
dizement, by  any  of  the  things  that  are  unworthy. 

By  these  means  the  whole  thing  is  determined —the 
most  useful  calling  or  the  least  useful  calling,  according  to 
the  way  in  which  it  is  used. 


568  HENRY     B  A  I  R  D     F  A  V  I  L  L 


Delivered,  Abraham  Lincoln  Center,  Chicago,  November  7,   1907. 
Prinfed,  Unity,  December  5,  1907. 

CIVIC   PIETY 

IF  the  situation  in  which  I  find  myself  this  evening 
seems  as  strange  to  you  as  it  does  to  me,  you  must 
all  wonder  what  I  can  have  to  say  that  is  worth  your 
attention. 

The  theme  in  its  general  sense  is  hackneyed  and  what- 
ever one  says  is  in  danger  of  being  trite.  There  is  neither 
side,  nor  shape,  nor  color,  nor  shade  of  this  appeal  to  civic 
spirit,  which  is  not  as  familiar  to  you  as  your  daily  paper. 
There  is  not  a  reason  or  an  argument  that  has  not  been 
adduced  a  thousand  times  to  dull  your  apprehension  and 
lull  your  alertness.  There  is  no  direction  in  which  valorous 
effort  to  achieve  better  things  has  not  been  made  under 
your  vision.  There  is  not  a  degree  of  disappointment  or 
futility  that  has  not  been  forced  upon  your  attention  through 
years  of  civic  development. 

The  question  clearly  arises  whether  the  theme  is  not 
threadbare;  whether  the  project  is  not  unsound,  whether 
the  path  to  social  accomplishment  is  not  as  yet  undiscovered. 
Upon  that  query  my  mind  has  fixed  itself  times  without 
number,  and  for  an  answer  I  have  but  one  conclusion. 

As  a  matter  of  talk,  the  thing  has  been  overdone,  but 
as  to  action  —  that  is  another  story. 

An  eccentric  young  boy  friend  of  mine,  being  persistent- 
ly chided  by  his  mother,  when  she  said  to  him,  "My  boy, 
mother  does  not  like  to  keep  nagging  at  you,"  replied, 
"Oh,  never  mind,  mother,  I  do  not  mind  your  nagging 
at  all." 

It  is  an  epitome  of  the  philosophy  of  inconsequent 
agitation.  A  bugle  would  lose  all  its  power  if  it  were  used 
as  a  musical  instrument.  The  call  of  the  sentinel  stands 
out    as    a    dramatic    episode   in    military  life.     If   it  were 


M  I  s  c:  E  L  I.  A  N  I-:  O  U  S  569 

repeated  aimlessly  it  would  he  as  any  other  prattle.  And 
so,  it  is  seriously  possible  to  fritter  away  in  speech  not  only 
the  initiative  but  the  elemental  vitality  of  men,  by  the 
cheapening  of  emotion  and  turning  of  ideals  into  wax-works 
for  exhibition. 

Far  be  it  from  me  to  discredit  the  spiritual  uprising  to 
an  eloquent  appeal,  but  out  of  that  very  appreciation  must 
come  a  shrinking  from  the  repetition  that  leads  through 
familiarity  to  contempt  or  at  least  non-attention. 

But  as  to  work,  how  shall  we  feel?  Has  what  has  been 
done  been  futile?  Are  the  struggles  of  the  faithful  foolish? 
Is  the  comparative  smallness  of  result  really  insignificant? 

Let  us  realize  the  difference  between  minuteness  and 
insignificance.  What  has  been  done  in  sociologic  progress 
is  but  as  a  drop  in  the  bucket,  but  that  drop  has  colored 
the  entire  mass  and  is  so  significant  that  by  its  testimony 
we  are  carried  back  to  our  elemental  faith,  encouraged  on 
and  on  to  our  best  aspirations. 

We  like  to  think,  and  we  take  great  comfort  in  the  ex- 
pression, that  the  people  can  be  trusted.  This  respectable 
sentiment  needs  modification  to  have  it  of  any  worth.  The 
fact  is,  that  the  people  can  be  trusted  awake,  and  the  fact 
equally  is,  that  the  people  are  a  negligible  quantity  asleep. 
It  is  upon  this  discrimination  that  the  life  of  democracy 
depends.  It  is  upon  the  tendency  of  the  people  to  slumber 
that  the  abuses  of  organized  society  are  rooted.  It  is  upon 
the  hope  of  awakening  the  people  that  the  prospects  of  the 
future  depend. 

We  have  a  theory  of  social  organization,  government, 
if  your  choose,  which  presupposes  action  through  delegated 
authority.  Our  theory  entitles  us  to  repose  in  the  belief 
that  our  delegates  will  faithfully  and  intelligently  do  their 
duty.  The  whole  world  is  coming  to  a  conception  of  altruism 
and  philanthropy^  that  lays  upon  the  community  the  obli- 
gation to  maintain  a  reasonable  possibilit}-  of  living,  either 
by  government  management  or  common  effort. 


570  HENRY     BAIRD     FAVILL 

Under  neither  of  these  conceptions  has  the  result  been 
satisfactor\^  The  effort  of  the  people  to  maintain  living 
conditions  has  b}^  no  means  kept  abreast  of  the  difficulties 
which  surge  upon  us  through  the  development  of  our  in- 
dustrial life. 

Our  governmental  function  directed  toward  social  better- 
ment is  too  limited  in  scope  and  too  vague  in  interpretation 
to  even  approximately  keep  pace  with  the  difficulties.  The 
people's  delegates  in  official  life  are  neither  as  intelligent 
nor  as  trustworthy  as  our  theory  demands.  The  fact  is,  so 
far  as  the  demonstration  of  our  government  is  concerned, 
we  have  not  yet  reached  the  point  where  there  is  any  safety 
without  unremitting  scrutiny  from  the  electorate.  Whether 
we  should  ever  reach  such  a  point  upon  any  theory  is  a 
question,  but  the  voice  of  the  people  at  this  time  needs  to 
be  heard  unmistakably  and  unceasingly. 

It  has  been  said  of  many  a  politician  and  statesman, 
with  more  or  less  just  reproach,  that  "he  has  his  ear  to  the 
ground."  What  is  ordinarily  implied  in  that  statement  is 
distinctly  a  reservation  upon  statesmanship  and  a  limitation 
upon  independent  thought.  Moreover,  history  shows  clearly 
enough  that  the  movements  of  the  people  in  mass  and  under 
emotion  are  unsafe  and  not  infrequently  unsound. 

There  is  every  reason  why  the  machinery  of  the  gov- 
ernment should  be  so  constructed  as  to  permit  deliberate 
action  and  thought  on  the  part  of  the  people,  necessitating 
influence  upon  officials,  somewhat  indirect. 

Right  here  lies  the  practical  difficulty.  We  have  al- 
lowed indirectness  of  contact,  the  presence  of  intermediate 
factors,  to  cramp  our  conception  of  personal  responsibility. 
The  same  mental  operation  is  to  a  very  large  extent  re- 
sponsible for  the  inertness  of  a  community  with  reference 
to  its  social  abuses.  I  carefully  avoid  using  the  word  in- 
difference. I  do  not  believe  that  this  community  is  indiffer- 
ent to  the  woes  of  its  submerged  or  even  its  overstrained 
members,  but  that  it  is  inert,  ignorant,  and  inoperative, 


M  I  SC  FCL  L  A  N  ICO  n  S  57  I 

awfully  so,  in  view  of  llic  vastness  of  its  opportunities,  I 
can  not  deny. 

I'he  warmth  and  syin])alhy  of  individuals  who  become 
enlisted  in  sociolo^ic  work  fully  justifies  one's  belief  in  fun- 
danu-ntal  interest.  The  heart-breaking  tu^'  that  is  required 
to  enlist  enouj^^h  interest  to  determine  efTective  and  con- 
tinuous movement  is  a  sufficient  evidence  of  the  apathy 
of  the  i)eo]3le  in  general.  How  can  we  account  for  this 
contradiction  ?  What  is  the  reason  that  people  who  would 
care,  do  not  care?  That  those  who  would  help,  do  not  lift  a 
finger?  That  those  who  could  furnish  irresistible  numbers, 
leave  the  work  to  a  handful? 

There  must  be  some  very  good  reasons,  and  what  those 
reasons  are,  is  worth  painstaking  study  on  the  part  of  every 
person  in  this  audience. 

Bear  in  mind  that  there  is  a  very  great  difference  between 
a  reason  and  an  excuse.  I  maintain  that  there  is  no  excuse. 
I  have  not  the  wisdom  satisfactorily  to  set  forth  all  the 
reasons,  but  I  have  a  few  suggestions  which  I  feel  disposed 
to  put  forth  for  your  consideration. 

In  all  the  departments  of  our  civic  life,  and  this  is  partic- 
ularly true  of  this  country,  there  is  one  thing  which  impresses 
me  deeply.  Admirable  as  are  the  efforts  and  achievements 
of  men  and  groups  of  men  in  various  directions,  the  thing 
which  operates  most  to  limit  effectiveness  is  the  gap  which 
is  permitted  to  exist  between  phases  of  work  which  are 
related  and  should  be  in  immediate  sequence.  In  in- 
numerable directions  we  do  admirable  bits  of  work, 
specialized  according  to  the  nature  of  the  work.  Almost 
as  frequently  the  work  falls  short  of  its  full  result  by  reason 
of  the  fact  that  it  does  not  "hitch  on"  to  its  immediate 
successor  or  predecessor,  in  the  sociologic  procession. 

Let  me  illustrate:  The  dispensaries,  for  the  treatment 
of  the  sick  undertake  to  afford  a  statement  as  to  what  is 
the  matter  and  advice  as  to  what  to  do  about  it.  In  the 
nature  of  things,  the  advice  is  for  the  most  part  useless, 


572  HENRY     BAIRD     FA  V  ILL 

because  under  the  existing  conditions  the  resources  which 
we  need,  to  be  drawn  upon  for  practical  appHcation  of  the 
advice,  do  not  exist.  Inestimable  time,  effort,  and  money 
are  to-day  wasted  upon  that  illogical  situation. 

Our  hospitals,  really  of  high  grade,  and  doing  admirable 
service,  from  that  restricted  standpoint,  abruptly  terminate 
their  service  with  the  discharge  of  the  patient,  irrespective 
of  his  social  condition,  prospects,  or  resources.  An  enor- 
mous percentage  of  patients  so  discharged  inevitably  drift 
back  again  to  the  hospital,  to  pauperism,  to  crime,  or  to 
unknown  things. 

The  necessity  to  connect  relief  work  with  that  critical 
moment  of  discharge  from  the  hospital  is  perfectly  evident, 
and  fortunately  is  now,  in  this  community,  being  accom- 
plished. 

Upon  these  very  same  gaps  in  our  political  operations 
depend  the  possibilities  for  shiftless,  ineffective  or  corrupt 
administration. 

Whenever  there  is  careful  inquiry  into  the  detail  of 
administrative  processes,  the  lack  of  coordination  and  eco- 
nomical cooperation  becomes  distressingly  clear,  and  so, 
with  reference  to  the  electoral  machinery,  disconnected 
effort,  no  matter  how  well  intended,  permits  almost  un- 
restricted play  of  pernicious  political  intrigue  to  our  infinite 
disadvantage.  But  for  our  purposes  to-night,  the  chasm 
which  is  most  impassable,  which  in  my  judgment  accounts 
most  satisfactorily  for  the  lack  of  general  participation  in 
public  affairs,  is  that  which  lies  between  the  interested  and 
willing  citizen  and  the  work  which  he  sees  but  does  not 
know  how  to  do. 

In  politics  there  is  an  astonishing  diffidence  on  the  part 
of  the  average  citizen  as  to  even  offering  to  mix  in  with  it. 
In  sociologic  work  there  is  a  strong  self-distrust  on  the 
part  of  people  as  to  their  fitness  or  ability  to  cope  with  it. 

I  have  no  doubt  that  the  first  step  from  private  and 
personal  pursuits  to  public  and  civic  pursuits  is  the  only 


M  I  S  C  E  T>  [.  A  N  E  O  U  S  573 

difficult  step  there  is.  The  intelHgent  man  or  woman  says, 
"Lo,  this  boundless  task!  Who  am  I?  What  can  I  do? 
How  can  I  become  a  valuable  instrument  in  this  process?" 

The  question  is  pertinent  and  the  answer  to  my  mind 
is  perfectly  clear.  Belong  to  something  that  works.  Ally 
yourself  with  an  organization  or  organizations  which  have 
serious  purpose  and  are  steadfastly  pursuing  it.  If  there 
is  no  organization  which  fits  the  need  which  you  feel,  make 
one,  but  whatever  you  do,  do  not  stay  on  the  outside. 

Fortunately,  there  is  machinery  of  which  you  can  be- 
come an  indispensable  part.  In  every  direction  there  are 
organizations,  any  one  of  which  would  offer  you  scope  and 
inspiration.  If  the  organization  to  which  you  belong  is 
doing  nothing,  indict  it,  plead  with  it,  reorganize  it  and 
vitalize  it.  Any  concrete  organization,  no  matter  for  what 
originally  devised,  will  serve  as  a  nucleus  for  civic  enter- 
prise. There  exist  in  this  city  organizations  grappling 
with  problems  of  civic  life  that  are  unlike  and  unequalled 
by  any  organizations  in  the  world.  Every  day  in  the 
week  there  are  non-official  congregations  of  men,  dealing 
disinterestedly  and  solely  with  public  affairs,  with  an  ear- 
nestness and  with  an  intelligence  that  is  not  found  in  any 
other  great  city  in  the  country. 

There  is  no  excuse  for  the  inactivity  of  the  citizen  who 
wants  to  do  his  duty,  on  the  ground  of  lack  of  opportunity, 
and  there  is  no  excuse  for  the  citizen  who  does  not  want  to 
do  his  duty,  on  any  ground. 

What  the  organizations  which  now  exist  most  need  is 
workers,  interested,  earnest,  efficient  workers. 

What  they  next  need  is  money.  I  think  I  may  safely 
say  to  any  able  bodied  member  of  this  audience  that,  as 
between  your  contribution  in  mone^^  and  your  contribution 
of  yourself  to  any  civic  work,  the  contribution  of  yourself 
would  be  more  valuable  and  more  eagerly  welcomed. 

It  is  unnecessary  to  argue  the  limitation  which  there 
is  upon  the  time  and  strength  which  the  average  citizen, 


574  HENRY     BAIRD     FAVILL 

business  man  or  home-maker  can  contribute.  The  indi- 
viduals who  can  be  suddenly  projected  into  active  work 
must  have  both  reasonable  amount  of  time  and  superfluous 
strength,  but  any  individual  who  can  not  give  of  himself 
a  reasonable  measure,  but  who  can  give  from  his  resources 
a  portion,  is  under  an  absolute  moral  orbligation  to  do  it. 
What  this  should  be,  how  it  shall  shape  itself,  is  a  matter 
for  individual  conscience,  but  the  time  is  past  when  any- 
body can  quietly  sit  back  and  say,  "It  is  none  of  my  affair." 

The  sense  of  responsibility  must  be  awakened  in  the 
individual.  Academic  discussion  has  its  place.  Intelli- 
gence is  the  very  root  of  improvement,  but  intelligence  is 
not  mere  knowledge.  It  is  understanding,  and  understand- 
ing comes  by  leaps  and  bounds,  as  one  becomes  actively 
enlisted  in  the  work. 

Discouragement  comes  too, — all  phases  of  realization 
of  personal  and  corporate  inadequacy,  but  against  that 
poison  there  is  one  certain  antidote;  that  is  labor,  effort, 
determination  to  attack  the  next  thing  at  hand,  and  con- 
quer it  or  be  conquered,  but  in  any  event  to  be  alive. 

As  I  have  said,  there  is  a  special  hesitation  on  the  part 
of  the  average  citizen  in  entering  into  political  activity. 
Even  where  there  is  profound  interest  and  conviction,  one 
is  embarrassed  to  know  how  to  go  at  it. 

The  attitude  of  the  self-appointed  politician  and  of  our 
elected  officers  varies  all  the  way  from  patronizing  tolerance 
to  sublime  contempt.  Let  us  not  blink  the  fact  that  our 
practical  inefficiency  justifies  the  one,  and  our  unwillingness 
to  make  deep  sacrifice  permits  the  other.  The  refined  and 
peace  loving  mind  finds  abundant  justification  in  literature 
for  holding  aloof,  but  the  citizen  with  insight  and  conviction 
will  find  as  potent  literary  stimulus  to  uphold  his  ambition 
to  do  his  part. 

Channing  wrote,  "Politics,  however  they  make  the  in- 
tellect active,  sagacious,  and  inventive,  within  a  certain 
sphere  geneially  extinguish  its  thirst  for  universal  truth, 


M  I  S  C  IC  L  L  A  N  IC  O  U  S  575 

paralyze  sentiment  and  imagination,  corrupt  the  simplicity 
of  the  mind,  destroy  that  confidence  in  human  virtue  which 
lies  at  the  foundation  of  philanthropy  and  generous  sacri- 
fices and  end  in  cold  and  ])rudent  selfishness."  A  wonder- 
fully comforting  sentiment  to  those  who  wish  to  withdraw 
from  the  struggle. 

Alexander  Hamilton,  however,  laid  f]r>wn  this  general 
principle:  "The  amehoration  of  the  condition  of  mankind 
and  the  increase  of  human  happiness  ought  to  be  the  lead- 
ing objects  of  every  political  institution  and  the  aim  of 
every  individual,  according  to  the  measure  of  his  power  in 
the  situation  he  occupies,"  and  Wendell  Phillips  said, 
' '  Responsibility  educates,  and  politics  is  but  another  name 
for  God's  way  of  teaching  the  masses  ethics,  under  the 
responsibility  of  great  present  interests." 

But  way  back  at  the  beginning  Cato  declared,  and  this 
sentiment  should  be  as  much  ours  as  his,  "Some  have  said 
that  it  is  not  the  business  of  private  men  to  meddle  with 
government, — a  bold  and  dishonest  saying,  which  is  fit  to 
come  from  no  mouth  but  that  of  a  tyrant  or  a  slave.  To 
say  that  private  men  have  nothing  to  do  with  government 
is  to  say  that  private  men  have  nothing  to  do  with  their 
own  happiness  or  misery ;  that  people  ought  not  to  concern 
themselves  whether  they  be  naked  or  clothed,  fed  or  starved, 
deceived  or  instructed,  protected  or  destroyed."  It  is  our 
business;  —  no  man  can  relieve  us  of  the  responsibility. 
No  man  shall  gainsay  our  right  to  participate. 

And  now,  in  conclusion,  let  me  say  one  earnest  word. 
The  attention  of  the  people  directed  upon  their  govern- 
ment should  not  limit  itself  to  criticism.  The  tendency  of 
the  inexperienced  is  to  find  fault. 

The  only  way  to  be  just  in  judgment  of  public  matters 
as  of  private  matters  is  to  understand  them.  The  onty  w^ay 
fairly  to  judge  your  neighbor  or  your  alderman  is  to  know 
him, — not  necessarily  intimately,  but  fairly  and  with  full 
knowledge  of  the  facts. 


576  HENRY     BAIRD     FAVILL 

We  are  prone  to  feel  that  virtue  is  its  own  reward  and 
that  a  trustworthy  officer  needs  no  commendation,  encour- 
agement, or  upholding.  Nothing  is  further  from  the  truth. 
Alderman  after  alderman  has  gone  through  the  City  Council, 
struggled,  been  honest,  done  his  best,  and  retired  in  utter  dis- 
couragement at  the  lack  of  appreciation  shown  him  by  his 
constituents. 

What  this  community  needs  is  not  destructive  criticism, 
but  constructive  cooperation. 

A  few  years  ago  Howard  Crosby  said,  "To  let  politics 
become  a  cesspool  and  then  avoid  it  because  it  is  a  cess- 
pool is  a  double  crime.  No  man  should  be  a  partisan  in 
the  sense  of  one  who  votes  for  his  party,  right  or  wrong." 

Have  you  no  way  to  meet  this?  Are  there  no  means 
at  your  hand  to  mobilize  your  integrity,  to  concentrate 
your  interest,  and  to  focus  your  effort? 

Ask  the  man  who  is  responsible  for  this  organization 
which  calls  us  together  to-night.  Reflect  upon  the  lesson 
of  these  years  of  his  activity.  Consider  the  verdict  that 
history  will  put  upon  his  activities. 

This  community  needs,  needs  badly  and  now,  public 
sentiment  that  can  be  promptly  and  powerfully  arrayed. 
Given  the  best  of  sentiment,  the  problem  of  bringing  it 
into  efficient  operation  must  depend  upon  discipline.  The 
way  to  discipline  is  through  organization.  The  answer  to 
the  citizen  who  does  not  know  how  to  bring  to  bear  his 
powers,  and  asks  his  way,  is,  Enlist. 


M  r  S  C  K  T.  T,  A  N  R  O  U  S  577 

PrinLfd  in  ;i  work  on  Mculiciil  BioKnipliy,  lyoH. 

SKETCH   OF   JOHN    FAVH>L,    M.D. 

BORN  in  i8ig.  Diedini88,^  He  lived  and  practiced 
in  Madison,  Wisconsin,  from  1848  until  1883.  He 
was  a  general  ])ractitioner,  —in  his  later  years,  how- 
ever, doing  nothing  of  surgery,  except  in  obstetrics. 

He  was  born  in  Brockett's  Bridge,  town  of  Manheim 
(now  Dolgeville),  Herkimer  County,  N.  Y. 

He  was  of  parentage  directly  American,  the  son  of  John 
Favill  and  Elizabeth  Guile  Favill,  who  were  of  English 
descent  and  remotely  French. 

He  received  a  common  school  education,  supplemented 
by  several  years  at  Fairfield  Academy,  and  was  graduated 
in  medicine  at  Harvard  University  in  1847. 

He  was  a  member  of  the  Wisconsin  State  Medical  Society 
and  was  its  President  in  1872.  He  was  a  member  of  the 
Wisconsin  State  Board  of  Health  from  the  day  of  its  organ- 
ization, 1876,  until  1882. 

In  1854  he  married  Louise  Sophia  Baird  of  Green  Bay, 
Wisconsin,  the  second  daughter  of  Henry  S.  Baird  and 
Elizabeth  (Fisher)  Baird.  They  had  four  children,  one  of 
whom  died  in  infancy.  Those  living  are,  Therese  Schindler 
Favill,  Henry  Baird  Favill,  and  Eleanor  Bumside  Favill 
(Tenney).     The  son  is  a  practitioner  of  medicine  in  Chicago. 

Dr.  Favill  died  at  Madison,  Wisconsin,  December  9, 
1883,  two  days  after  a  cerebral  hemorrhage. 

His  writings  were  few,  the  chief  being  his  President's 
address  to  the  Wisconsin  State  Medical  Society  in  1872, 
"The  Relation  the  Profession  Holds  and  Ought  to  Hold 
Toward  the  Communit3^"  and  "Mental  Hygiene,"  contrib- 
uted to  the  first  proceedings  of  the  Wisconsin  State  Board 
of  Health  in  1876. 

Dr.  Favill  was  preeminently  a  man  of  character;   gentle, 

20 


578  HENRY     BAIRD     FAVILL 

deliberate,  rational,  resolute,  and,  upon  a  moral  issue,  in- 
flexible. 

His  professional  life  was  that  of  a  general  practitioner, 
in  its  early  3^ears  partaking  of  all  the  vicissitudes  of  country 
practice. 

He  was  not  given  to  writing,  but  was  an  influential  mem- 
ber of  the  medical  societies  and  a  regular  attendant  upon 
their  meetings.  His  was  the  day  of  ardent  opposition  to 
all  that  was  "irregular"  in  practice.  Upon  that  issue  he 
was  pronounced  and  of  deep  conviction. 

In  his  personal  professional  relations,  he  was  punc- 
tilious to  the  extreme; — being  a  man  of  sound  judgment 
in  medical  affairs  and  with  profound  insight  into  humanity ; 
his  counsel  in  abstract  professional  matters  was  potent,  and 
as  a  counsellor  in  practice,  he  was  widely  sought  and  im- 
plicitly trusted. 

His  influence  upon  the  ethical  relations  existing  between 
the  physicians  amongst  whom  he  practiced  was  signal. 
The  profession,  wherever  he  touched  it,  looked  to  him  to 
ensure  harmony  and  dignity,  and  without  exception  he  was 
recognized  as  just. 

Intellectually  he  was  broad  and  profound,  rather  than 
analytical.  His  estimate  of  value  in  the  current  of  medical 
thought,  kaleidoscopic  as  are  its  changes,  was  almost  unerring. 

As  an  item  of  knowledge,  the  new  was  always  interest- 
ing to  him,  and  the  sifting  of  fact  from  fancy,  a  matter  of 
deep  concern;  but  he  was  never  carried  away  by  spectac- 
ular discoveries,  though  he  had  singular  prescience  as  to 
what  was  likely  to  prove  true.  And  he  possessed  unusual 
judgment  in  the  administration  of  medical  resources  already 
established. 

In  the  broader  field  of  human  affairs,  his  mind  was 
untrammelled  by  tradition.  His  utterances  of  forty  years 
ago,  markedly  at  variance  with  the  prevailing  thought  at 
that  time,  stand  out  to-day  fully  abreast  of  the  most  en- 
lightened opinion. 


M  I  S  C  K  r.  F.  A  N  K  O  U  S  579 

Ill's  views  ,'is  (•x])rcssc(l  in  his  rirlicle  "Mental  Hygiene" 
mijj^lit  !)(•  (Jic  U'xl  for  a  modern  discussion  of  that  subject, 
fundamental  as  is  the  reformation  it  has  undergone  since 
his  day. 

This  is  thoroughly  characteristic  of  him  as  a  thinker, 
and  in  all  directions  his  conception  of  an  ethical  problem, 
familiar  as  it  would  be  to  his  friends  through  speech  rather 
than  by  writing,  is  remembered  as  remarkably  advanced. 

It  is  as  a  friend,  however,  that  his  greatest  contribution 
to  the  life  of  his  community  must  be  recognized.  Neither 
the  poor  nor  the  rich,  the  able  nor  the  feeble,  were  outside 
of  his  sympathy.  To  everyone  his  strong,  well  balanced, 
unselfish  friendship  was  open.  Charity  for  the  evil-doer, 
patience  with  the  arrogant  well-to-do,  and  abounding  re- 
spect for  the  poor  strongly  colored  his  life  and  his  demean- 
or; and  normally  reacting  to  this,  all  sorts  and  conditions 
of  men  met  him,  each  on  his  own  ground,  with  open  mind 
and  heart. 

In  his  family  he  was  guide,  philosopher,  and  friend,  in- 
dulgent in  impulse,  clear  in  counsel,  and  patient  beyond 
measure  under  the  developing  characteristics  of  his  children. 

The  stamp  he  put  on  his  community  is  indelible.  His 
influence  was  always  in  the  direction  of  self-reliance,  rous- 
ing, encouraging,  stimulating,  but  demanding  from  those 
he  helped  proportionate  effort  on  their  part. 

The  mark  of  these  deep  relationships  of  my  father  is 
still  to  be  found  widely  distributed  among  lives  separated 
from  each  other  at  every  point  but  this:  their  recognition 
of  the  power  of  a  noble  personality. 


58o  HENRY     BAIRD     FA  V  ILL 


Delivered,  Memorial  Services,  Sunday,  February  2,  1908,  Music  Hall, 

Fine  Arts  Building,  Chicago. 
Printed,  Bulletm  of  the  Alumni  of  Rush  Medical  College,  February,  1908. 

NICHOLAS   SENN   AS   A   PHYSICIAN 

THE  career  of  Nicholas  Senn  illustrates  that  a  man 
is  not  made  by  circumstances.  The  self-made  man, 
as  we  call  him,  is  a  common  enough  figure,  but  the 
man  who,  out  of  unpropitious  beginnings  and  inadequate 
facilities,  steadily  has  forced  himself  not  only  to  material 
success  but  to  high  and  higher  levels  of  scientific  standard, 
is  rare. 

Perhaps  the  most  noteworthy  fact  in  the  professional 
development  of  Doctor  Senn  is  that  his  greatest  and  most 
enthusiastic  scientific  achievements  were  during  a  period 
when  his  daily  toil  in  medical  practice  was  the  most  burden- 
some. After  completing  his  medical  schooling  and  serv- 
ing in  the  Cook  County  Hospital,  he  plunged  into  the  thick 
of  country  practice.  Promptly  he  was  recognized  as  a  man 
of  strength  and  progress,  and  very  early  in  his  career  at- 
tracted the  attention  and  commanded  the  respect  of  the 
profession  of  Wisconsin.  Steadily  he  forged  ahead,  not 
only  in  his  private  practice,  but  in  public  recognition. 
Interested,  indefatigable  and  effective,  it  was  but  a  question 
of  a  few  years  when  he  naturally  and  inevitably  sought,  ill 
Milwaukee,  a  broader  field  for  his  activities.  There  he  con- 
tinued, aggressive,  original,  and  inspiring. 

I  have  never  known  a  man  whose  capacity  for  sustained 
labor,  not  for  a  few  days,  but  month  after  month,  was  as 
great  as  that  of  Doctor  Senn.  In  this  fact,  coupled  with  his 
indomitable  perseverance,  lies  the  explanation  of  his  remark- 
able production  during  the  period  from  1880  to  1895.  His 
professional  success,  his  leadership,  his  triumphant  dem- 
onstration of  his  ability  during  this  period,  might  easily 
have  satisfied   any   ambition.     To  him  these  were  minor 


M  I  S  C:  K  I.  I.  A  N  KO  U  S  581 

considerations.  To  he  ;i.  physician  was  his  passion,  and  he 
brought  into  his  labors  every  contributory  resource  that 
was  at  that  time  available. 

The  effect  of  his  commanding  supremacy  upon  the  pro- 
fession of  Wisconsin  was  pronounced.  He  never  held  the 
place  of  rival  or  competitor;  he  was  the  acknowledged 
leader,  and  young  men  drew  from  him  inspiration  and 
encouragement.  In  those  days  and  in  the  later  days  of 
his  brilliant  medical  teaching  his  precept  focused  not  upon 
final  surgical  achievement,  but  upon  the  broad  principles 
underlying  morbid  conditions.  Generalization  and  the 
whole  morbid  picture  was  far  more  satisfying  than  his 
surgical  technique. 

Not  at  all  early  in  his  career  did  he  become  specifically 
a  surgeon.  Never  in  his  career  did  he  become  only  a  sur- 
geon. As  he  reached  his  full  maturity,  the  dawn  of  scien- 
tific medicine  occurred.  He  was  amongst  the  first  to  grasp 
the  enormous  significance  and  possibilities  of  the  new  life; 
day  and  night  he  labored  with  the  scientific  problems  of 
medicine,  always  with  the  broad  relationships  of  the  living 
organism  as  the  background  to  his  conception. 

At  this  period  he  acquired  the  deep  friendship  and 
respect  of  Dr.  Christian  Fenger,  and  the  picture  of  those 
two  masters,  shoulder  to  shoulder  during  those  days  of 
medical  conflict,  demonstration,  and  revolution,  is  never 
to  be  forgotten.  The  friendship  furnished  him  untold 
comfort  and  inspiration  in  his  scientific  pursuit,  and  as  a 
result  of  it  the  medical  profession  in  the  western  states  has 
profited  inexpressibly. 

In  his  early  life  he  had  an  enormous  experience  in  general 
practice.  In  his  later  life  he  unfailingly  interpreted  his 
surgical  problems  in  the  light  of  his  broad  medical  experi- 
ence. Those  who  have  encountered  him  realize  that  there 
was  no  territory  of  general  medical  thought  in  which  he 
had  not  an  expert  judgment.  Voluntarily  putting  aside 
all   that   was   not   specialized   work,   he   nevertheless   was 


582  HENRY     BAIRD     FAVILL 

competent  to  assume  any  medical  responsibility,  and  to 
this  fact  is  due  largely  the  notable  conservatism  which 
characterized  his  surgical  views. 

No  man  knew  better  than  he  the  triumphs  and  possi- 
bilities of  operative  management.  No  one  was  less  carried 
away,  by  enticing  possibilities,  from  the  sound  footing  of 
medical  judgment.  In  many  directions,  the  evolution  of  med- 
ical thought  went  past  him,  fell  back  of  him,  and  finally 
stands  at  this  moment  abreast  of  a  position  which  through 
it  all  he  steadily  maintained.  To  his  breadth  of  view  as  to 
the  human  body,  in  other  words,  to  his  all  around  develop- 
ment as  a  physician,  is  due  this  recognized  soundness. 

In  other  directions  not  technical,  in  the  broad  human 
relationships  between  doctor  and  patient,  he  maintained 
an  equal  poise.  Occupying  a  position  where  he  could  have 
arbitrarily  commanded  extreme  material  rewards,  he  habit- 
ually maintained  a  conservative  attitude.  His  patient's 
real  interest  was  his  interest,  and  he  rarely  was  beguiled 
into  the  sophistries  of  modern  professional  relations. 

To  the  mind  unaccustomed  to  consider  medical  special- 
ization in  its  effect  upon  individuals,  these  reflections  may 
not  seem  so  important,  but  to  the  medical  mind  fully 
appreciating  the  dangers  and  disadvantages  of  too  narrow 
lines  of  thought  and  activity,  the  characteristics  of  Doctor 
Senn  stand  out  not  only  as  noteworthy,  but  as  offering  a 
demonstration  that  breadth  and  depth  are  not  incompatible. 

Surgery  owes  him  an  inexpressible  debt,  but  those  who 
knew  him  best,  and  particularly  during  the  greater  part 
of  his  life  when  he  was  an  active  factor  in  general  medical 
affairs,  know  that  his  greatest  contribution  to  the  interest, 
intensity,  ideals,  and  scientific  conception  of  medicine  was 
as  a  physician. 


M  I  SC;  ELL  AN  ICC)  i;  s  583 


Delivered,   Seeoml    Ainiii.il     I'.;iii(|iie1 ,    Wisconsin    Society    of    Chicajjo, 

|)(  I'cinlier    IS,    i';io. 
Prinled,  Ainm;il  KepniM  . 

OUR    LAKEvS   AND    W(X)i;S 

I  AM  more  than  gratified  at  the  gentle  decency  of  your 
toastmaster's  allusion  to  me.  Inasmuch  as  he  has 
known  me  intimately  under  conditions  which  try  men's 
souls,  I  consider  the  gentle  irony  of  his  remarks  to  be  rather 
a  peace  offering.  In  fact,  I  am  disposed  to  paraphrase 
Kipling's  couplet  in  the  " Fuzzy wuzzy"  and  say,  "All  that 
I  have  got  from  'im  is  pop  to  what  he  might  'av  made  me 
swaller." 

The  fact  is,  in  so  far  as  I  have  either  initiative,  capac- 
ity, or  inspiration  in  wood-craft  and  mountain  lore,  I  ac- 
quired them  under  the  skillful  tutelage  of  your  accom- 
plished toastmaster.  I  will  not  pretend  that  it  was 
an  easy  school  of  instruction.  He  is  critical,  rigid,  and 
infallible.  That  he  is  a  mighty  hunter,  no  one  doubts. 
That  he  is  an  interesting  and  convincing  raconteur  is  a 
matter  of  record.  The  fact  that  in  the  bosom  of  his  family 
he  is  known  as  "Opie  Dilldock"  is  no  qualification  of  my 
statement.  He  is  essentially  a  veracious  chronicler  and  his 
lore  is  subtle  and  intense.  His  is  not  the  crass  observa- 
tion of  the  stumbling  lumberjack,  nor  the  sentimental 
claptrap  of  the  amateur  "outer."  His  is  the  keen  eye  of 
the  falcon  and  the  cunning  of  the  fox.  In  the  woods  he 
sees  everything  that  is  there  and  much  that  is  not,  and 
in  the  refinements  of  his  observations  will  put  to  test  and 
to  shame  the  faculties  of  ordinary  men.  So,  when  I  pay 
him  this  tribute,  I  at  the  same  time  record  my  gratitude 
that  he  has  not  told  all  that  he  could. 

He  and  I  were  boys  together  in  Wisconsin,  in  the  same 
town,  mth  the  same  lakes  and  woods  and  fields  and  hills 
upon  which  to  acquire  our  facility  and  from  which  to  derive 


584  HENRY     BAIRD     FAVILL 

our  springs  of  enthusiasm  for  the  beauties  which  Wisconsin 
can  offer.  As  I  recall  those  early  days,  no  life  that  could 
be  offered  to  a  boy  seems  to  me  more  ideal;  the  broad 
expanses  of  water  in  which  to  swim  and  sail,  of  ice  on  which 
to  skate  and  ice-boat,  of  woods  in  which  to  roam,  of  hills 
upon  which  to  coast,  of  surrounding  marshes  and  water- 
courses in  which  to  hunt;  it  seems  as  though  everything 
was  there  that  could  be  asked. 

As  I  go  back  to  it  now,  it  is  true,  the  lakes  do  not  look 
so  large,  the  hills  are  not  so  high  nor  so  steep,  the  woods 
are  gone,  and  the  general  touch  of  settlement  and  civili- 
zation has  wiped  out  much  of  the  original  beauty  and 
freedom,  but  after  all,  the  memory  of  those  early  days 
can  never  be  effaced  and  the  joys  of  that  boyhood  never 
excelled. 

In  those  days,  I  had  a  very  vague  idea  about  the  magnifi- 
cence of  Wisconsin.  To  be  sure,  Madison  was  the  capital, 
the  seat  of  government,  of  education,  of  courts,  and  a  place  of 
general  importance.  I  suppose  that  my  outlook  was  broad- 
er than  that  of  most  boys  from  other  parts  of  the  State, 
in  consequence  of  these  facts.  I  had  a  considerable  knowl- 
edge of  local  State  history  for  various  reasons.  I  knew  the 
natural  boundaries  of  the  State;  that  it  was  bounded  by 
Lake  Michigan,  by  the  Mississippi  River,  on  the  south  by 
the  greed  and  dishonesty  of  Illinois,  but  never,  until  I  was 
introduced  into  the  woods  of  northern  Wisconsin,  did  I 
realize  the  essential  reasons  for  its  northern  boundary. 
To  those  who  live  in  that  country,  it  is  often  a  question  why 
the  northern  peninsula  of  Michigan  does  not  belong  to 
Wisconsin,  as  it  geographically  ought  to.  To  those  whose 
knowledge  of  that  country  is  gained  from  the  study  of 
railroad  folders,  the  idea  is  common  that  there  is  no  land 
at  all  in  northern  Wisconsin,  but  a  conglomeration  of  lakes, 
streams,  and  marshes.  To  none  of  these  does  it  seem  clear 
why  the  boundary  is  as  it  is.  One  who  knows  the  lay  of 
the  land  reahzes  that  there  is  an  essential  reason.     Along 


M  I  S  C:  K  L  I.  A  N  K  O  TJ  S  585 

the  northeast  l)oun(I;iTy  of  Wisconsin  there  is  a  watershed. 
Upon  this  side  of  the  Wisconsin  boundary  the  water  entcTS 
into  Wisconsin.  Upon  the  further  side  the  water  flows 
into  Lake  Superior.  On  a  pinch  this  might  be  regarded  as 
a  natural  division,  but  it  would  be  artificial.  The  gist  of 
the  matter  is  this:  On  the  Wisconsin  side  of  that  watershed 
is  found  the  intrepid  muskelonge.  On  the  Superior  side  of 
that  watershed  is  found  the  base  imitation,  the  pickerel. 
This  constitutes  the  essential  reason  for  this  State  bound- 
ary line.  Wisconsin  has  chosen  for  her  sons  the  game  worthy 
of  their  metal ;  she  has  handed  over  to  her  neighbors  of  less 
sportsmanlike  quality  one  fitted  for  their  metal;  and  so,  I 
say,  that  Wisconsin  is  bounded  on  the  north  by  the  muske- 
longe. 

And  now,  let  me  say  in  all  seriousness  and  with  a  con- 
viction profound,  that  northern  Wisconsin  has  to  offer  to 
the  world  a  priceless  treasure. 

For  many  years  I  have  cherished  in  my  memory  a  treas- 
ure of  literary  thought  that  has  been  a  source  of  incalcula- 
ble treasure  and  profit.  The  woman  who  wrote  this  beauti- 
ful story  is  Harriet  Prescott  Spofiford,  and  inasmuch  as  I 
proffer  it  from  memory  it  may  not  be  quite  accurate,  but 
I  am  more  than  glad  to  pay  the  tribute  that  I  owe  to  this 
author  for  the  inspiration  that  lies  in  this  quotation. 

The  story  is  of  a  young  Ameiican  woman,  married  to  a 
foreign  noble,  and  when  about  to  be  delivered  of  her  first 
child,  she  goes  under  traditional  guidance  to  the  ancestral 
castle.  There,  in  the  perturbation  of  her  troublesome  days, 
preceding  and  following  her  trial,  she  is  struck  with  a  measure 
of  horror  at  certain  of  the  endowments  which  she  feels  her 
child  must  have.  She  recognizes  her  child  as  the  offshoot 
of  a  long  line  of  more  or  less  decadent  aristocracy^  and  feels 
the  accumulated  weight  of  civilization's  weaknesses  as  they 
surround  her  babe,  and  during  this  perturbation  of  mind 
she  has  a  dream,  and  in  her  vision  the  various  ancestors, 
represented  in  portraits  about  the  hall,  seem  to  step  from 


586  HENRY     B  A  I  R  D     F  A  V  I  L  L 

their  frames  and  come  down  and  give  to  this  babe  their 
various  gifts,  and  as  each  one,  of  whom  she  knows  the  more 
or  less  sinister  history,  makes  a  bestowal  upon  her  babe, 
she  has  a  renewed  thrill  of  terror.  What  can  they  possibly 
give  to  her  child  which  would  not  be  a  burden  and  a  menace? 
But  finally  there  steps  down  from  her  place  the  ancestral 
mother,  semi-barbaric,  uncivilized,  untrammelled,  and  un- 
touched by  the  deteriorations  of  that  social  system,  and 
she  seems  to  pronounce  over  this   child  these  words: 

"Waken,  my  manchild,  and  take  from  me,  thy  first 
mother,  my  gifts,  thou  child  of  all  weather  and  of  out-of- 
doors.  I  give  thee  will  and  might  and  love  of  the  undefiled. 
I  give  thee  strength  of  my  rivers,  my  forests,  my  seas,  my 
sunshine,  my  starshine,  and  of  my  heart.  I  cleanse  thee. 
The  slime  of  long  years  shall  drop  from  thee.  I  start  thee 
afresh,  newborn.  At  night,  in  my  star-hung  tent,  the  gods 
shall  visit  thee.  By  day  thou  shalt  walk  in  ways  to  become 
as  a  god  thyself.  I  give  thee  scorn  of  the  ignoble,  trust  in 
thy  fellows,  firm  belief  in  thine  own  lusty  muscle  and  un- 
conquerable will.  I  make  thee  familiar  friend  of  hardship 
and  content,  spare  and  pure  and  strong.  I  give  thee  joy 
of  the  earth,  the  wind,  the  sun,  and  belief  in  the  unseen. 
This  is  thy  birthright." 

To  be  possessed  of  the  spirit  of  that  benediction  is  to  be 
turned  back  free  and  untrammelled  upon  the  elemental 
paths  of  human  experience,  stripped  of  the  dross  of  com- 
petitive life,  strengthened  by  the  sense  of  fundamental 
heart-given  power,  and  inspired  by  the  vision  of  that  per- 
fectly attainable  simplicity  which  belongs  to  the  clear  eye, 
steady  head,  and  decisive  acts. 

Every  thoughtful  man  has  periods  of  discontent  in  which 
he  recognizes  the  limitations  of  social  existence  and  longs 
for  that  freedom  of  mind  and  body  which  gave  character 
to  his  ancestral  type,  which  has  been  lost  in  the  develop- 
ments of  civilization. 

Often  this  longing  is  not  clear  enough  to  be  recognized. 


M  I  S  f ■  K  F.I,  A  N  E  O  l)  S  (jS; 

UsiKilly,  tlirouj^li  force  of  firctiinstances,  it  is  smothered  Vjy 
immediate  didicull-ies.  We  reaeh  out  with  childlike  eager- 
ness for  somethinj^,  wc  know  not  what,  that  will  bring  us 
into  communion  with  what  Kipling  calls  "The  Trues," 
with  more  or  less  helplessness,  or  stumble  along  knowing 
not  the  path,  and  so  adhering  to  our  wonted  way. 

Perhaps  there  are  many  ways  of  reaching  out  into  life 
to  satisfy  our  craving  for  a  sim])lcr,  tnier,  and  more  digni- 
fied experience,  but  of  all  the  ways  that  present  themselves, 
none  has  more  to  offer  than  that  which  leads  into  the  wilder- 
ness. There  lie  all  the  charms  and  hardships,  all  oppor- 
tunities for  patience  and  fortitude  and  joyousness  and 
oblivion.  To  one  who  interprets  the  call  of  the  wilderness 
truly,  it  speaks  in  terms  of  simplicity.  It  has  to  offer  no 
pampering  luxury,  no  belittling  trivialities,  no  useless 
pastimes.  The  wilderness  demands  of  her  devotees  willing- 
ness to  meet  her  conditions,  strength,  courage,  judgment, 
and  patience,  but  when  she  finds  these  offered  upon  her 
altar  she  returns   in  many  fold  and  lavishes  her  rewards. 

If  you  furnish  the  courage  wherewith  to  endure  hard- 
ship, in  the  end  she  will  furnish  content.  It  is  that 
achievement,  the  gift  of  being  content  under  conditions  of 
discomfort,  that  is  worth  all  the  price  that  one  can  pay  for 
the  experience,  and  so  I  say  that  Wisconsin,  with  her 
wonders  of  wilderness,  offers  to  her  sons  and  neighbors  an 
opportunity,  to  come  back  out  of  that  maelstrom  of 
civihzation  confusion  into  the  clear  waters  of  elemental 
purity  and  power.  She  invites  them  to  assert  and 
appreciate  their  kinship  with  all  the  things  that  live,  to 
reach  out  into  the  universe  and  feel  a  sympathetic  touch 
with  the  beasts  of  the  field,  to  aspire  to  a  strength  and  self- 
reliance  in  which  the  merest  infant  of  beast  surpasses  the 
wisest  man. 

So  far  as  I  know,  in  no  other  way  can  one  approach  this 
strong  and  self-respecting  footing  except  by  meeting  and 
coping  with  adverse  physical  condition. 


588  HENRY     B  A  I  R  D     F  A  V  I  L  L 

In  no  other  words  can  I  so  fitly  sum  up  this  feeling  as  in 
those  of  our  Comrade  Badger,  Hamlin  Garland: 

"Do  you  fear  the  force  of  the  wind, 
The  slash  of  the  rain  ? 
Go  face  it  and  fight  it. 
Be  savage  again. 

Go  hungry  and  cold  like  the  wolf. 
Go  wade  like  the  crane. 
The  palm  of  your  hand  will  thicken, 
The  skin  of  your  cheek  will  tan. 
You'll  grow  ragged  and  weary  and  swarthy, 
But  you'll  walk  like  a  man." 


M  I  S  f:  E  L  L  A  N  K  O  (J  S  589 


I Jflivcrc'd,  Fcbrii.'iry,  191 1. 

SUPPORTING  tup:  candidacy  of 

C.    E.    MERRIAM    FOR    MAYOR 
OF   CHICAGO 

THE  medical  profession  has  awakened  to  the  idea  that 
it  has  a  duty  to  the  pubHc  of  far  wider  significance 
than  its  ordinary  function  of  treating  disease.  In 
recent  years  it  has  become  evident  that  there  are  possibilities 
in  prevention  of  disease  —  in  preservation  of  health — that 
outweigh  the  possibilities  of  cure  of  disease  an  hundred  fold. 
To  the  propagation  of  this  intelligence,  to  the  effective  ad- 
vancement of  practical  sanitation  and  hygiene,  the  medi- 
cal profession  is  committed.  As  time  goes  on,  the  measure 
of  usefulness  of  medical  science  is  destined  to  be  its  power 
in  accomplishing  real  protection  of  the  public  against  all 
forms  of  disease.  The  physicians  are  the  natural  leaders 
in  this  movement.  They  are  educated  in  the  facts,  experi- 
enced in  the  problems,  and  charged  by  society  with  this 
responsibility.  Can  they  shirk  it?  The  fact  is,  that  the 
medical  profession  is  not  shirking  it.  The  further  fact  is, 
that  the  effort  is  one  attended  with  the  gravest  discourage- 
ments, and  we  may  well  ask.  Why? 

There  are  many  reasons,  but  one  in  particular  is  funda- 
mental and  almost  universal.  It  is  failure  on  the  part  of 
administrative  officers  and  bodies  to  see  the  importance  of 
the  matter. 

Protection  of  the  mass  of  the  community  can  not  be 
reached  without  an  active  and  determined  policy  of  admin- 
istration. Not  only  must  the  governing  power  be  open  to 
the  truth  in  these  matters;  it  must  be  aggressive  in  its 
measures  to  combat  conditions  that  endanger  the  citizens 
who  are  helpless  as  individuals  to  raise  a  finger  in  their  own 
defense.     It  is  difficult  for  those  who  have  not  practical 


590  HENRY     BAIRD     FAVILL 

experience  to  realize  that  disease  is  to  a  large  extent  pre- 
ventable, to  a  moderate  extent  controllable,  to  a  small 
extent  curable. 

The  "waste  of  disease  from  any  point  of  view  is  appalling. 
The  medical  profession  utters  its  loudest  protest  against 
conditions  that  permit  and  encourage  this  indefensible 
weakness  in  our  social  conditions,  and  as  individuals  they 
can  do  no  more.  The  result  is,  that  physicians  find  scope 
for  their  efforts  to  insure  the  public  weal,  and  encourage- 
ment in  the  barter,  just  in  proportion  to  the  intelligence, 
honesty,  and  fearlessness  of  the  public  health  policy  of  any 
administration.  National,  State,  or  Municipal. 

An  administration  that  has  a  clear  conception  of  its 
duty  and  freedom  to  perform  that  duty  can  give  to  every 
physician  full  measure  of  opportunity  to  cooperate.  An 
administration  that  has  not  that  conception,  or  that  is 
hampered  by  political  bonds  that  make  its  policies  weak 
and  futile,  must  of  necessity  stifle  individual  effort  to  act 
for  the  general  good  through  the  channels  of  government. 

On  the  other  hand,  no  administration  of  the  health 
policy  of  any  community  can  be  a  success  without  the  cor- 
dial cooperation  of  the  physicians.  The  most  important 
question  that  a  physician  can  face  in  his  decision  as  to 
where  he  should  place  his  allegiance  in  a  municipal  election 
is,  What  is  likely  to  be  the  situation  upon  this  gravest  of 
matters?  It  is  not  a  fit  subject  for  prejudice  or  partisan- 
ship. It  is  a  question  involving  the  deepest  welfare  of  the 
community  and  the  most  profound  sense  of  obligation  to 
protect  it. 

We  are  in  the  midst  of  a  fierce  struggle  to  elect  our 
municipal  officers.  Never  have  the  issues  been  clearer  cut 
than  they  are  to-day.  The  Mayor  is  the  controlling  force 
in  this  question  of  public  health  policy.  No  ability  on  the 
part  of  his  appointee  is  of  any  avail  if  his  policy  is  not  be- 
yond criticism.  Such  a  policy  must  be  intelligent  and  free. 
No  idling  behind  the  defenses  of  traditional  methods,  no 


M  I  SC  EL  L  A  N  lO  O  (J  S  591 

helplessness  under  the  weight  of  ]jolitical  shackles.  The 
physician  who  values  his  usefulness  in  its  broader  aspects 
must  himself  answer  this  question.  In  this  campaign,  who 
is  to  be  relied  upon  to  see  his  responsibilities  and  to  be  able 
to  fulfill  them  ? 

Upon  every  citizen  that  question  ought  to  weigh.  Upon 
the  physician  it  is  a  specific  burden.  He  knows  the  need. 
He  knows  the  complexity.  He  knows  the  history  of  the 
past.  What  will  he  decide?  This  is  not  a  mere  question 
of  who  shall  be  the  Commissioner  of  Health.  It  is  far 
greater  than  that.  It  is,  Shall  the  force  to  whom  is  en- 
trusted the  active  work  of  the  department  be  selected  upon 
the  basis  of  competency,  or  upon  a  basis  of  "influence?" 
Shall  the  work  of  the  department  be  untrammelled  or  shall 
it  be  rejected  to  the  pressure  of  political  expediency? 

The  answer  that  the  citizen  can  give  to  these  questions 
should  determine  his  decision  as  to  his  vote  and  influence. 

For  me,  it  is  clear.  Charles  E.  Merriam  is  a  man  of  the 
broadest  training  in  the  science  of  government.  His  inter- 
est has  been  in  human  advancement  and  not  in  politics. 
His  clear  understanding  of  public  questions  led  his  fellow 
citizens  to  push  him  into  politics.  Being  there,  his  views 
are  clear,  sound,  and  practical.  He  realizes  that  no  subject 
is  more  important  than  the  Public  Health.  His  attitude 
will  be  unequivocal  and  his  policy  all  that  can  be  desired. 

Will  he  be  able  to  carry  out  his  plans?  Wh}^  not?  He 
has  not  given  one  promise.  He  has  not  bartered  for  one 
office.  He  has  not  bound  himself  by  one  pledge,  except  to 
serve  the  people.  That  is  his  distinction  and  his  strength. 
He  is  known  to  have  sound  knowledge  of  office.  He  is 
known  to  have  high  ideals.  He  is  known  to  be  free.  Could 
anybody  be  more  safe? 

For  no  class  of  citizens  are  these  issues  clearer  than  for 
physicians. 


592  HENRY     BAIRD     FAVILL 


Printed,  Survey,  May  6,  191 1. 

REMARKS   ON   THE   REPORT   OF   THE 
VICE   COMMISSION 

THE  printed  report  of  the  Chicago  Vice  Commission 
is  a  remarkable  document.  Those  who  have  been 
aware  of  the  activities  of  the  commission  are  not  sur- 
prised at  the  thoroughness  of  the  work  described.  To  any- 
one unfamiHar  with  existing  conditions  this  exposition  must 
be  a  tremendous  shock.  To  set  before  the  average  citizen 
in  unequivocal  terms  and  in  detail  unmistakably  reliable 
the  facts  of  the  underworld  is  a  task  enormously  difficult, 
deeply  instructive,  and  as  a  rule  thoroughly  distasteful  to 
the  citizen.     All  of  these  things  pertain  to  this  report. 

There  is  more,  however,  to  the  work  of  this  commission 
than  mere  industry  or  insight.  The  report  sounds  a  clear, 
courageous,  and  more  or  less  hopeful  note  as  to  what  to  do. 
It  is,  of  course,  obvious  that  the  recommendations  are  not 
uniformly  clear  as  to  desirability.  There  can  be  no  ques- 
tion that  agitation,  education,  and  the  correction  of  public 
sentiment  are  fundamental  to  considerable  and  lasting 
reform.  There  can  be  many  questions  and  differences  of 
opinion  as  to  the  recommendations  of  immediate  procedure 
intermediate  between  the  present  status  and  a  future  regen- 
eration. Nevertheless,  the  commission  advises,  positively, 
steps  of  immediate  procedure  representing  its  judgment 
as  to  what  is  both  feasible  and  effective. 

In  view  of  the  uncommonly  strong  makeup  of  the  com- 
mission, these  recomm.endations  should  be  received  with  the 
greatest  respect.  The  tendency  of  men,  in  particular  those 
who  have  general  knowledge  of  these  subjects,  is  to  shrug 
their  shoulders.  The  generalities  as  to  what  "always  has 
been  and  always  will  be,"  "human  nature,"  and  all  that 
line  of  talk  which  comfortably  disposes  of  the  whole  matter 


M  I  S  C  E  I,  L  A  N  !•:  ()  (J  S  593 

by  doin^  nothing,  are  too  familiar  to  require  discussion. 

This  supincness  is  not  necessarily  indifference.  It  is  to 
a  larj^e  extent  discouragement  born  of  observation  as  to  the 
futility  of  social  agitation.  The  view  is  superficial.  P'utility 
is  apparent  rather  than  real.  An  undercurrent  of  reform  is 
obvious  to  students  of  the  situation. 

It  must  be  borne  in  mind  that  the  commission  is  neither 
questioning  history  nor  attempting  to  change  "human 
nature."  It  is  endeavoring  to  discern  in  the  light  of  history 
and  human  nature  what  is  to  be  done  with  a  pestilence 
which  has  assumed  abnormal  proportions  in  the  course  of 
the  developments  of  civilization,  and  whose  bearings  and 
interrelations  are  by  reason  of  our  present  stage  of  evolution 
different  from  any  propositions  which  history  or  human 
nature  has  hitherto  presented. 

The  great  difficulty  in  reform  movements  is  in  corre- 
lating and  stabilizing  the  machinery  of  correction.  This, 
the  commission  means  to  secure  by  a  fixed  commission  as 
to  policy  and  a  fixed  court  as  to  current  dealing.  The  faint- 
hearted will  look  upon  these  things  askance,  as  likely  to  be 
ineffective.  The  sinister  elements  will  of  course  oppose 
them.  But  the  merit  of  the  situation  will  lie  in  having  boldly 
uncovered  the  matter  and  established  machinery  which  shall 
deal  with  it  in  the  open,  thereby  on  the  one  hand  limiting 
the  quasi-criminality  of  the  police  and  administration  con- 
nivance or  profit-sharing,  and  on  the  other  keeping  awake 
the  civic  sensibilities  of  the  public,  which  hitherto  has  taken 
refuge  and  received  comfort  in  ignorance. 

The  recommendations  are  worthy  of  trial  and  the  work 
of  the  commission  beyond  measure  to  be  commended. 


594  HENRY     B  A  I  R  D     F  A  V  I  L  L 


Delivered,     Fourth     Annual     Boys'    Dinner,    Chicago    Association    of 

Comrnerce,  December  21,  191 1. 
Printed,  Chicago  Commerce,  December  29,  191 1. 

WISHBONES   AND   BACKBONES 

IT  is  rather  customary  for  us  elders  to  deplore  the  non- 
continuity  of  our  wisdom;  to  deplore  the  fact  that  our 
sons  do  not  listen  to  us,  do  not  learn  from  us,  do  not 
profit  by  our  experience.  Many  of  us  have  come  to  think 
that  that  is  inevitably  inherent  in  the  nature  of  the  boy 
and  man  relation.  Many  of  us  have  come  to  think  that 
that  is  desirable  upon  the  hypothesis  that  a  boy  can 
not  learn  except  by  experience  and  that  he  can  not  really 
have  a  sound  footing  until  he  has  been  knocked  down  a 
few  times. 

I  believe  neither  of  these  things  to  be  true  and  I  con- 
sider it  really  a  great  waste  from  a  humane  standpoint  that 
we  who  have  worked  so  hard,  felt  so  much,  suffered  so 
much,  and  enjoyed  so  much,  should  not  be  able  to  start  our 
boys  along  farther  in  the  race  than  we  were  started.  And 
although  it  is  not  true  that  they  do  not  start  farther  in  the 
race  than  we  started,  it  is  true  that  they  do  not  start  as  far 
along  in  the  race  as  they  might. 

But  is  this  voluntary  with  them?  Is  it  because  the  boy 
is  incorrigible  or  bullheaded  or  wilful  or  conceited  that  he 
is  not  able  to  avail  himself  of  these  fountains  of  wisdom 
which  we  offer  him  ?  How  well,  gentlemen  of  the  elder  class 
here,  have  we  done  our  part?  How  clearly  have  we  blazed 
the  way  ?  How  honest  have  we  been  in  letting  the  boys  see 
the  real  foundations  of  our  experience  and  getting  the  real 
picture  of  our  life  struggles  that  we  are  trying  to  impress 
upon  them  for  their  benefit?  I  maintain  the  fault  is  not 
with  the  boys.  The  fault  is  with  us,  and  with  a  much  too 
large  extent  are  we  letting  authority  stand  for  instruction. 

In  this  country  more  than  in  any  other  country  there  is 


M  I  s  (■  i<:  I.  F>  A  N  i<:  f)  u  s  595 

one  war  cry,  a  rallyinj^  cry  for  almost,  all  iK30ple,  and  that  is 
business;  and  there  is  every  reason  why  it  should  he  so.  In 
the  first  place,  it  represents  the  dignity  of  employment.  In 
the  second  place  it  represents  the  method  of  the  mainte- 
nance of  our  individual  status  and  strength  in  the  com- 
mimity.  It  is  but  another  expression  for  commerce  which 
history  will  show  us  clearly  is  the  absolute  measure  of  the 
development  of  the  human  race. 

Commerce  has  come  to  be  the  measure,  the  mark  of 
civilization ;  and  so  business  or  commerce  or  all  of  the  ideas 
involved  in  that  indirect  mixture  of  thought  have  come  to 
have  for  the  people  of  this  country  an  enormous  authority 
and  an  enormous  value.  It  makes  no  difference  where  we 
look,  whether  to  politics,  religion,  or  philanthropy,  or  soci- 
ological development  of  any  kind,  wherever  the  figure  leads 
us  we  find  ourselves  always  correlating  to  the  question  of 
business.  What  is  the  business  aspect  of  this  particular 
problem  ? 

I  am  not  going  to  quarrel  with  that  status  nor  to  take 
any  considerable  exception  to  the  frame  of  mind  of  those 
who  are  sharply  responsive  to  that  idea,  but  I  do  want  to 
take  occasion  to  call  the  attention  of  the  young  men  who 
have  not  fully  analyzed  this  subject  to  the  fact  that  there 
are  two  sides  to  that  question.  Commerce  and  civilization 
going  hand  in  hand  represent  the  dominion  of  man  over 
nature,  if  you  like,  over  things.  They  represent  the  utili- 
zation of  our  resources,  the  command  of  the  difficulties  of 
life.  They  represent  all  of  culture,  they  represent  all  of 
the  features  of  comfort  of  living,  and  to  that  extent  they 
are  almost  to  be  worshipped  as  being  of  worth  and  dignity. 
But  this  is  the  thought  that  I  want  to  put  in  at  this  point, 
namely,  that  the  dominion  of  man  over  things  always  goes 
hand  in  hand  with  the  dominion  of  things  over  man.  There 
is  the  point  where  the  checking  up  in  this  situation  falls 
on  the  shoulders  of  those  who  are  intelligent  enough  and 
thoughtful  enough  to  see  it. 


596  HENRY     BAIRD     FAVILL 

The  establishment  and  utiHzation  of  great  resource  goes 
hand  in  hand  with  the  greed  that  gathers  in  those  resources 
for. the  future.  The  estabHshment  of  great  elements  of  cul- 
ture or  comfort  or  physical  well-being  goes  hand  in  hand 
with  that  enormously  exaggerated  tendency  to  exploit  and 
display  the  resources  available  to  us,  leading  us  to  that 
much  deplored  ostentation  to  which  the  so-called  higher 
grades  of  civilization  are  prone.  And  more  than  that,  the 
very  possession  of  all  the  possible  facilities  for  comfort,  for 
enjoyment,  for  convenience,  for  time-saving,  going  into  our 
general  estimate  of  happiness,  deteriorates  with  hardly  a 
turn  of  the  hand  into  the  most  destructive  luxury,  and 
therein  lies  perhaps  the  most  important  danger  and  menace 
to  the  American  people  to-day  in  the  ranks  of  those  who  are 
fortunately  situated  as  to  material  things. 

The  tendency  to  develop  goes  hand  in  hand  with  the 
tendency  to  degenerate,  and  whether  it  is  mental  or  moral 
or  physical,  the  effect  of  undue  availability  of  the  luxuries 
of  life  is  the  most  damaging  and  the  most  dangerous  thing 
which  we  as  a  people  have  to  face.  So  it  is  that  the  Asso- 
ciation of  Commerce  as  a  representative  of  the  people  finds 
itself  under  the  obligation  to  maintain  the  integrity  of  its 
field  of  influence,  whatever  that  may  be,  by  a  rigorous  scru- 
tiny of  the  elements  which  enter  into  its  activity,  and  a 
determination  to  eliminate  from  the  field  of  its  activities 
those  things  which  it  regards  as  pernicious.  And  the  Asso- 
ciation of  Commerce,  as  it  budded  forth  into  its  full  manhood 
from  its  somewhat  recent  youth,  came  to  see  that  it  was 
necessary  that  it  be  something  more  than  a  commercial 
organization;  that  it  was  necessary  for  the  full  develop- 
ment of  its  function  in  the  world  for  it  to  have  very  distinctly 
a  purpose.  This  is  no  more  true  of  the  Association  of  Com- 
merce than  it  is  true  of  you  or  of  me.  The  fact  is  that  the 
determining  fact  of  life  so  far  as  men  and  women  are  con- 
cerned is  the  purpose  of  the  life,  and  the  purpose  of  the 
life  is  a  very  definite  and  distinct  one. 


M  I  s  (•  I-:  1.  F.  A  N  r-:  o  u  s  597 

Lei  me  call  your  aUcntion  to  the  fact  that  there  is  a 
great  difference  l)etween  a  desire  and  a  purpose.  There  is  a 
great  difference  between  a  wish  and  a  will.  Why,  you  know 
the  old  saying  —  I  don't  know  who  said  it  —  "Never  wear 
your  wishbone  where  your  backbone  ought  to  be."  That 
is  the  keynote  of  the  development  of  character  in  men  or 
in  organizations,  and  this  organization  saw  that  very  early. 
What  did  it  do? 

The  first  thing  it  did,  by  some  process  or  other  —  and  I 
would  be  too  personal  and  would  be  regarded  too  much  as 
retaUating  upon  your  courteous  toastmaster,  if  I  were  more 
personal  about  it  —  by  some  process  there  awoke  in  the 
association  a  civic  conscience,  and  it  has  developed  enor- 
mously. It  is  hard  to  find  a  simile  that  fits  it  in  dignity  and 
worth.  The  Association  of  Commerce  early  came  to  see 
that  the  affairs  of  this  world  perhaps  were  not  everybody's 
business  because  if  everybody's  business  is  nobody's  busi- 
ness the  Association  of  Commerce  declined  to  accept  the 
conclusion,  and  decided  right  then  and  there  that  anything 
that  was  not  distinctly  anybody  else's  business  was  its 
business,  and  from  that  time  it  has  been  its  business. 

In  the  very  beginning  this  was  foreshadowed,  but  it  has 
come  on  in  recent  years,  particularly  in  the  last  year  or  two, 
to  the  point  where  the  Association  of  Commerce  does  not 
hesitate  to  take  cognizance  of  any  public  question  whether 
it  is  distinctly  a  commercial  question  or  not;  any  question 
which  affects,  as  Mr.  Wheeler  puts  it,  the  shareholders  of 
this  corporation,  becomes  the  object  of  scrutiny  and  analysis 
and  dealing  with  by  the  Association  of  Commerce  in  some 
fit  and  taking  way. 

Such  a  thing  as  this  has  never  happened  before  to  this 
extent  and  with  these  results  in  any  civic  body  that  ever 
existed.  The  result  of  it  is  that  the  Association  of  Com- 
merce has  determined  for  itself  a  status  and  a  position 
in  this  community,  the  influence  and  importance  of  which 
can  not  be  measured. 


598  HENRY     B  A  I  R  D     F  A  V  I  L  L 

Early  in  the  game  it  put  to  itself  this  question:  "Am  I 
my  brother's  keeper?"  And  following  along  the  genius  of 
civilization,  following  along  the  thought  that  has  come  to 
dominate  all  serious  and  right-minded  people  in  the  world,  it 
answered  that  question  affirmatively,  "I  am  my  brother's 
keeper  to  any  extent  that  my  obligation  indicates."  But 
beyond  that  came  this  question,  as  it  always  comes  as  the 
concrete  development  of  that  query:  "Not  only  am  I 
my  brother's  keeper,  but  am  I  my  own  keeper?"  because 
every  man  comes  to  see  that  in  any  community,  great  or 
small,  but  particularly  in  a  great  complex  community  like 
this,  there  is  no  such  thing  as  an  isolated  evil.  There  is  no 
such  thing  as  an  evil  or  a  pernicious  process  or  a  vicious 
spot  which  can  stay  where*  it  starts.  It  does  not  make  any 
difference  whether  w^e  are  talking  about  the  vice  district  or 
the  saloon  question  or  tuberculosis  or  contagious  disease  of 
any  kind,  or  wages  or  strikes  or  what  it  is,  there  is  not  a 
question  that  can  arise  in  a  community  like  this  that  does 
not  become  inevitably  and  immediately  a  question  of  the 
whole  people. 

You  can  not  keep  segregated  any  festering  spot  in  the 
body  politic.  Therefore,  the  Association  of  Commerce  has 
said,  definitely  and  distinctly  and  aggressively:  "These 
things  are  our  business,  and  we  will  deal  with  these  things 
just  in  so  far  as  we  are  able.  So  it  comes  about  that  the 
Association  of  Commerce  deals  with  the  question  of  politics 
in  its  broadest  sense,  by  influencing  where  it  thinks  it  ought 
to  influence  the  administrative  bodies.  The  question  is, 
if  we  elect  administrative  bodies,  ought  they  to  run  their 
affairs  and  our  affairs  ?  And  the  answer  is,  in  a  limited  way, 
yes,  they  ought  to  be  responsible  and  held  responsible  for 
the  proper  execution  of  their  trust.  But  beyond  that 
limited  way,  the  answer  is,  no,  there  is  no  administrative 
body  that  is  as  wise  as  the  whole  body,  and  there  is  no  admin- 
istrative body  which  will  not  be  better  for  the  aggregate 
thought  of  this  organization  expended  upon  any  particular 


M  r  S  f ;  K  I>  L  A  N  !•:  O  U  S  599 

proposition.  And,  tlicrcforc,  Ibis  orj^anization  docs  not 
hesitate  in  a  ])ro])cr  way  and  by  its  jjroper  delegation  to 
undertake  to  advise  our  administrations  —  our  aflminis- 
trators  —  as  to  their  duties  in  matters  of  policy. 

vSo  it  is  with  reference  to  our  great  questions  of  charity, 
the  administration  of  our  charities,  those  sore  spots  in  the 
community  which  absolutely  are  so  fundamentally  and 
vitally  necessary.  The  Association  of  Commerce  goes 
right  to  the  root  of  that  matter  in  half  a  dozen  distinct 
ways  for  the  purpose  of  establishing  the  fact  that  that  busi- 
ness is  our  business  in  so  far  as  it  is  distinctly  nobody  else's 
business.  So  you  see  what  an  enormous  ramifying  structure 
this  organization  has  grown  to  be  and  will  grow  to  be.  You 
see  that  it  is  a  great  big  tree  whose  branches  reach  in  every 
direction,  a  central  body  whose  roots  reach  in  every  direc- 
tion, a  thing  absolutely  of  necessity,  vital  and  alive,  or  else 
it  would  stop. 

Now  to  the  young  men  in  this  organization  I  want  to  say 
that  the  Association  of  Commerce  offers  you  great  things 
in  your  personal  relationship  to  it  in  the  future.  It  offers 
you  opportunity.  It  offers  you  standing.  It  offers  3^ou 
business  help,  advice,  and  cooperation.  But  let  me  say  to 
you  frankly  that  the  Association  of  Commerce  needs  you  a 
great  deal  more  than  you  need  the  Association  of  Com- 
merce. Because  the  young  men  of  the  world  are  the  roots 
of  the  tree,  and  without  vitality  at  the  root,  without  that 
vitality  that  can  liberate  nourishment  for  the  whole  struc- 
ture, the  thing  will  die,  and,  though  we  are  liable  to  forget 
it,  it  is  absolutely  to  the  boys,  and  even  down  to  the 
children,  that  we  must  look  for  the  integrity  of  what  we 
have  created  and  for  the  progress  in  the  future. 

Why  are  the  young  men  so  vital  to  the  progress  of  things 
of  this  kind?  Is  it  because  they  have  energ\',  or  time,  or 
ingenuity,  or  ambition,  or  any  one  of  the  things  that  may 
enter  into  the  complex  of  the  strong  man  ?  It  is  those  in  a 
measure;  but  mark  vou,  far  and  awav  bevond  the  values 


6oo  HENRY     BAIRD     FAVILL 

that  inhere  for  young  men  in  any  of  these  or  in  all  of  these 
that  I  have  mentioned,  far  and  away  beyond  them  lies  the 
fact  that  young  men  have  ideals,  and  they  stick  to  their 
ideals  and  they  are  governed  by  their  ideals,  and  they  can 
not  be  governed  by  any  other  method.  Now,  that  is  the 
reason  why  the  hope  of  the  world  not  only  lies  in  young 
men,  but  justifiably  lies  in  young  men.  They  have  not  lost 
through  the  conflict  with  the  world  that  keenness  of  percep- 
tion as  to  their  ideals.  They  have  not  had  ground  off  the 
sharp  corners  of  distinction  in  their  ideals  that  we  who  have 
had  more  experience  have  had  ground  off.  They  are  not 
compromisers,  they  are  not  anything  in  the  nature  of  truck- 
lers or  cowards. 

Young  men  can  be  handled,  not  by  pressure,  not  by 
coercion,  not  by  cajolement,  but  only  so  far  as  my  observa- 
tion goes,  in  any  broad  way,  through  their  ideals.  And  for 
that  reason  the  Association  of  Commerce  is  looking  to  its 
young  men.  Representing  the  whole  of  society  by  the  figure 
of  the  tree,  we  must  find  the  roots  vital,  alive,  and  furnishing 
to  this  structure  the  sap  of  idealism,  in  order  to  have  what 
is  true  life,  the  combination  of  experience  and  ideals.  So 
the  wise  people  of  the  world  have  seen  always  that  the  thing 
to  do  is  to  look  to  young  men,  and  to  lead  young  men,  to 
inspire  young  men,  to  school  young  men,  and  finally  and 
greatest  of  all,  to  trust  young  men." 


M  I  SCELL  A  N  ICOU  S  Coi 


Delivered,  C'hirago  Society  of  Medical  History,  March  14,  1912. 

EARLY   MEDICAL   DAYS   IN   WISCONSIN 

IT  happens  occasionally  that  i  fall  into  conversation  with 
some  of  my  old  Wisconsin  friends,  particularly  those  of 
my  own  age,  and  oftentimes  physicians  and  .sons  of 
physicians,  with  whom  I  undertake  a  kind  of  reminiscence 
to  which  we  are  all  prone  when  the  opportunity  arises  to 
discuss  the  things  of  our  childhood.  As  the  talk  proceeds 
we  find  ourselves  dwelling  with  great  earnestness  and  with 
very  distinct  admiration  upon  many  of  the  figures  which 
have  been  prominent  in  the  early  history  of  the  medical 
affairs  of  Wisconsin.  Then  almost  inevitably  before  we 
have  done  with  these  reminiscences  we  arrive  at  the  con- 
clusion, either  expressly  or  by  implication,  that  "there 
were  giants  in  those  days."  Just  what  we  would  mean  by 
giants  is  perhaps  open  to  question,  and  just  how  clearly  our 
prejudiced  view  can  have  been  determined  by  the  actual 
facts,  is  perhaps  again  open  to  question,  but  it  is  interesting 
to  reflect  upon  those  other  days  and  to  pass  in  review  the 
figures  in  society  which  gave  to  those  days  their  significance. 

The  more  I  have  thought  about  it  recently  in  the  light 
of  a  possible  criticism  of  my  opinions,  the  more  clear  I  have 
become,  that  there  were  qualities  exhibited  by  the  men  of 
those  days,  so  permanent  and  so  outstanding  as  really  to 
justify  the  estimate  which  I  have  just  given. 

It  is  a  very  difficult  comparison  to  draw,  which  involves 
setting  in  contrast  men  of  different  generations,  in  respect 
to  any  of  the  qualities  which  are  subject  to  variation  under 
the  development  of  knowledge  and  technical  skill. 

Probably  there  is  no  department  of  human  knowledge 
in  which  the  foundations  have  so  radically  shifted  as  have 
those  of  medical  science.  To  compare  a  surgeon  of  the  '50's 
with  a  surgeon  of  to-day  involves  a  fundamental  estimate  of 


6o2  HENRY     BAIRD     FAVILL 

character,  utterly  ignoring  the  entire  territory  of  audacity 
in  process  or  success  in  resuks. 

It  is,  of  course,  impossible  to  make  a  just  comparison, 
and  yet  we  are  prone  to  dispose  of  the  knowledge  of  other 
days  with  a  self-satisfied  superiority,  and  to  assume  that 
though  all  our  predecessors  did  the  best  they  could,  they  did 
not  amount  to  much.  It  is,  therefore,  fruitless  to  attempt 
to  maintain  the  high  estimate  of  the  old  guard  by  any 
analysis  of  their  medical  skill. 

This,  however,  is  not  so  true  of  general  medical  practice 
as  it  is  of  scientific  attainment  or  surgical  practice.  The 
practice  of  medicine  has  always  been  and  perhaps  always 
will  be  a  decidedly  empirical  matter,  and  it  would  not  be 
an  unjust  method,  if  it  were  possible,  to  estimate  the  rela- 
tive empiricism  of  that  day  and  this. 

I  am  very  sure  that,  whereas  knowledge  from  our  present 
point  of  view  was  very  much  lacking  in  those  days,  wisdom 
was  much  in  evidence.  As  I  retrace  mentally  the  steps  of 
experience  that  I  have  had  with  the  physicians  of  the  old 
school,  and  arrange  the  facts  and  experiences  of  the  still 
older  days  that  have  come  to  my  knowledge,  I  reach  the 
conclusion  inevitably,  that  the  thing  which  impresses  me  so 
strongly  as  to  the  quality  of  the  earlier  physicians,  is  their 
capacity  for  serious  thought,  for  these  men  took  life  very 
seriously.  Not  only  was  their  attitude  with  regard  to  their 
medical  responsibilities  grave  and  deliberate  and  anxious, 
but  the  things  related  to  their  internal  professional  life, 
to  their  external  professional  relations,  to  their  standing 
amongst  themselves  and  before  the  public,  were  matters  of 
the  deepest  concern. 

It  is  perhaps  as  impossible  justly  to  estimate  the  men  of 
different  generations  upon  moral  questions  as  it  is  upon 
technical  questions,  because  the  canons  of  morality  in  many 
respects  are  as  shifting  as  are  the  dicta  of  science.  It  is 
nevertheless  pertinent  to  call  attention  to  the  fact  that  there 
was  in  these  men  a  tenacity  of  purpose  in  maintaining  the 


M  I  s  c  I-:  I.  [>  A  N  I-:  o  n  s  605 

dignity  of  llic  profession,  and  nii  uiiconipromising  and  fear- 
less determination  in  maintaining^  ethical  standards  of  all 
sorts,  that  is  by  no  means  generally  founfl  in  these  days. 
To  what  extent  the  modifications  of  modern  days  may  be 
right  or  desirable  is  (juite  beside  the  question.  The  point 
is  that  those  men  had  conceptions  and  convictions,  and  that 
they  stayed  by  them  with  a  vigor  and  singleness  of  mind 
which  one  now  rarely  sees  in  any  ])rofessiona1  field. 

It  is  imjjossible  to  generalize  al')Out  the  whole  profession 
of  any  State  at  any  period  after  it  is  l^rge  enough  to  be 
somewhat  diffuse,  but  those  of  us  whose  familiarity  with 
the  subject  began  in  the  '6o's  or  '70's  will  always  hold,  as 
outstanding,  a  group  of  men,  distributed  about  Wisconsin, 
whose  force  and  influence  and  quality  we  have  never  seen 
surpassed. 

It  is  noteworthy  also  that  these  men  were  not  particu- 
larly related  to  the  cities,  and  it  would  be  invidious  to  cite 
individuals  except  with  the  explanation  that  these  were  typi- 
cal of  conditions  and  by  no  means  included  the  entire  list 
of  significant  men.  For  the  sake  of  the  more  intimate  sig- 
nificance belonging  to  personal  acquaintance,  I  name  a  few 
of  the  men  whose  elder  years  lapped  over  upon  my  younger 
professional  years.  In  Green  Bay  there  was  Brett;  in  Ber- 
lin, N.  M.  Dodson;  in  Appleton,  Reeve;  in  Fond  du  Lac, 
Griffin;  in  Milwaukee,  Dousman,  Wolcott,  Marks,  and 
Bartlett;  in  Lake  Mills,  DuBois;  in  Oregon,  Fox  the  elder; 
in  Racine,  Machan;  in  Janesville,  Whiting;  in  Madison. 
Chapman  and  Favill;  in  Mineral  Point,  Van  Dusen;  in 
Portage,  Meacher  and  Waterhouse;  in  Prairie  du  Chien, 
Mason.  Every  one  of  these  men  was  a  factor  in  building 
up  a  coherent,  high-minded,  and  competent  medical  society 
in  Wisconsin. 

When  one  undertakes  to  analyze  the  conditions  under 
which  practice  was  done  in  Wisconsin  from  1840  to  18S0, 
and  has  a  full  realizing  sense  of  the  actual  day  to  day  diffi- 
culties of  pioneer  practice,  he  will  see  that  what  these  men 


6o4  HENRY     B  A  I  R  D     F  A  V  I  L  L 

did  was  not  only  significant,  but  deeply  vital,  and  projected 
by  them  consciously  as  their  contribution  to  a  stable  de- 
velopment of  professional  standards  which  they  intended 
should- be  worthy  the  heritage  of  professional  values  that 
were  to  them  of  paramount  importance. 

The  history  of  the  beginnings  of  the  Wisconsin  State 
Medical  Society  is  significant  of  these  conditions.  It  is  to 
be  borne  in  mind  that  when  the  Medical  Society  was  founded 
there  w^ere  practically  no  railroads  in  Wisconsin;  that  com- 
munication was  by  wheels,  or  runners,  or  on  horseback,  or 
on  foot.  Many  a  man  started  practice  in  Wisconsin  in 
those  days  with  only  a  horse  and  no  saddle,  and  one  or  two 
strong  men  I  have  known  without  even  a  horse,  making  their 
long  trips  on  foot.  It  is  historic  that  Dr.  Van  Dusen  of 
Mineral  Point,  who  never  missed  a  meeting  of  the  State 
Medical  Society,  would  drive  from  Mineral  Point  to  Mil- 
waukee and  back,  occupying  two  or  three  days  in  going  each 
way,  for  the  purpose  of  attending  a  meeting  of  the  Society. 
Though  this  is  perhaps  the  most  signal  act  of  devotion 
to  what  was  to  him  a  high  ideal,  evidences  of  sacrifices  of 
that  character  were  everywhere  displayed  by  the  men  who 
were  in  those  pioneer  times  imbued  with  the  idea  that  they 
owed  to  their  profession  obligations  which  were  paramount 
to  all  personal  considerations. 

These  were  the  days  of  punctiliousness  upon  matters  of 
professional  ethics.  This  was  the  time  of  the  deepest  feel- 
ing over  what  was  to  them  a  most  profound  and  obnoxious 
heresy,  Homeopathy.  Here  was  crystallized  the  doctrine 
upon  which  they  founded  their  ethical  status:  "Homeop- 
athy is  absurdly  false.  He  who  actually  believes  it,  is  an 
ignoramus.  He  who  does  not  believe  it  and  practices  it, 
is  dishonest.  Out  upon  him  in  either  case.  We  cannot 
countenance  consultation  in  either  case." 

Whatever  modification  of  principles  or  practice  with 
reference  to  this  question  has  come  in  recent  days  is  imma- 
terial.    We  have  but  to  consider  the  integrity  of  view  and 


MISCELLANEOUS  605 

motive  which  actuated  those  men  in  those  days.  It  was  not 
to  them  a  matter  of  h'kcs  or  dislikes,  or  a  matter  of  expedi- 
ency, or  a  matter  of  ability;  it  was  a  deep  moral  issue,  and 
from  their  premises  there  was  nothing  in  the  way  of  com- 
promise that  was  excusable. 

Tolerance  is  rarely  a  virtue.  It  is,  as  a  rule,  a  mat- 
ter of  adjustment  based  upon  a  growing  recognition  of 
mutual  weakness,  and  a  consequent  diminution  in  relative 
inequalities. 

So  in  other  matters  of  professional  conduct,  these  out- 
standing men  were  punctilious.  The  fine  shades  of  frater- 
nal ethics,  the  dignified  function  of  consultation,  a  conse- 
cration to  the  relief  of  the  needy,  were  all  defined  and 
refined  in  ways  which  we  rarely  see  now.  These  things 
were  not  matters  of  deliberate  plan  or  study.  They  were 
the  outcropping  of  character,  and  it  is  in  respect  to  charac- 
ter in  the  last  analysis  that  we  find  ourselves  designating 
them  as  "giants." 

The  growth  of  the  Wisconsin  State  Medical  Society  is 
very  significant  as  to  the  value  which  may  lie  in  professional 
organization. 

In  the  year  1841  the  Legislature  of  the  Territory  of 
Wisconsin  passed  a  bill  providing  for  the  organization  of 
county  and  district  medical  societies  and  incorporated 
The  Medical  Society  of  the  Territory  of  Wisconsin.  This 
bill  was  approved  February  19,  1841.  The  preamble  to 
the  bill  was  as  follows : 

Whereas,  well  regulated  medical  societies  have  been  found  to 
contribute  to  the  advancement  and  diffusion  of  true  science,  and 
particularly  of  the  healing  art,  therefore. 

Be  it  enacted,  etc. ;  and  then,  be  it  fiuther  enacted  that  Bushnell 
B.  Gary,  M.  K.  Darling,  Lucius  F.  Barbour,  Oliver  E.  Strong, 
Edward  McSherry,  E.  B.  Wolcott,  J.  C.  Alills,  David  Walker. 
Horace  White,  J.  P.  Russell,  David  Ward,  Jesse  S.  Hughitt, 
B.  O.  IMiller,  and  their  associates  are  hereby  authorized  to  meet 
at  Madison,  the  capitol  of  the  Territory  of  Wisconsin,  as  the 


6o6  HENRYBAIRDFAVILL 

Medical  Society  of  the  Territory  of  Wisconsin,  and  when  held 
under  such  name  shall  be  a  bod}^  politic  and  corporate;  shall 
have  perpetual  succession;  and  be  capable  of  contracting  and 
being  contracted  with,  issuing  and  being  issued,  defending  and 
being  defended,  pleading  and  being  impleaded,  in  all  courts  of 
law  or  equity;  and  may  have  a  common  council  and  alter  the 
same  at  pleasure;  and  shall  be  capable  of  holding  estate,  real, 
personal,  or  mixed  and  also  to  loan,  let,  or  sell  or  convey  the  same, 
provided  that  the  property  owned  by  the  said  association  shall 
not  in  the  whole  exceed  ten  thousand  dollars  ($10,000.00); 
provided  also  that  said  Society  shall  be  compiled  exclusively''  for 
the  promotion  of  medical  science. 

The  majority  of  the  said  incorporators  met  at  Madison 
at  the  proper  time  and  organized  the  Medical  Society  of  the 
Territory  of  Wisconsin  and  the  society  held  meetings  annu- 
ally. The  records  of  the  meetings,  however,  prior  to  1847, 
appear  to  have  been  lost  and  there  is  now  no  trace  of  them. 

On  Tuesday,  January  12,  1847,  the  society  met  at  Madi- 
son, and  there  being  only  a  few  present,  little  was  done. 
Dr.  M.  C.  Darhng  was  the  president  incumbent,  and 
Dr.  J.  C.  Dousman  was  elected  to  succeed  him;  Dr.  Henry 
Clark  was  secretary  pro  tern,  and  Dr.  C.  B.  Chapman  was 
elected  recording  secretary  for  the  ensuing  year. 

The  organization  of  the  Society  is  indefinite  but  it  is 
implied  in  the  following  statement  that  it  consisted  of 
temporary  and  permanent  members  as  this  memorandum 
shows.  Dr.  C.  B.  Chapman  of  Madison  and  Dr.  E.  A.  Mul- 
ford  of  Walworth  were  elected  permanent  members  of  the 
Society.  Dr.  Wolcott  introduced  a  resolution,  as  a  by-law 
of  society,  "that  membership  be  forfeited  if  a  member  does 
not  attend  for  two  years."  Also  a  resolution  that  the  con- 
stitution of  the  Wisconsin  Territorial  Medical  Society  "be 
so  alteied  that  the  annual  meeting  be  held  on  the  fourth 
Tuesday  after  the  first  Monday  in  January." 

These  two  resolutions  constitute  the  only  recorded  testi- 
mony of  the  existence  of  a  constitution  and  by-laws  of  the 
society  at  that  time. 


M  T  S  r  TC  I.  I.  A  N  ('■.  O  U  S  607 

However,  the  meeting  the  next  year  was  not  on  the  day 
stipulated  but  was  held  on  February  27,  1848,  the  memo- 
randuni  being  that  the  meeting  on  the  regular  day  lacked 
a  (|Uf)rinn. 

At  the  next  meeting  five  delegates  were  elected  to  attend 
the  next  meeting  of  the  American  Medical  Association  at 
Baltimore,  none  of  whom  attended.  Also  at  this  meeting 
resolutions  were  adopted  responding  to  the  call  of  the  New 
York  College  of  Pharmacy,  touching  the  adulteration  of  drugs 
and  the  importance  of  memorializing  Congress  on  the  subject. 

The  Territory  of  Wisconsin  having  previous  to  this  meet- 
ing become  changed  to  the  State  of  Wiscon.sin,  the  name  of 
the  organization  was  changed  to  the  Medical  Society  of  the 
State  of  Wisconsin.  Dr.  Dousman  was  elected  president; 
Dr.  Chapman,  recording  secretary. 

It  is  recorded  that  at  the  meeting  of  1849  three  delegates 
were  designated  to  attend  the  meeting  of  the  American 
Medical  Association  at  Boston,  but  none  attended.  It  is 
recorded  that  at  a  subsequent  meeting  at  Janesville  in  1849 
five  delegates  from  the  county  and  district  societies  attended, 
the  first  that  had  ever  come  from  the  local  societies,  so  far 
as  the  records  show.  There  is  implied  in  this  something  of 
the  organization  in  the  way  of  delegates  from  local  societies. 

At  this  meeting  a  recommendation  from  the  American 
Medical  Association  as  to  the  code  of  ethics  and  the  stand- 
ards of  preliminary  education  for  medical  status  was  laid 
on  the  table.  A  resolution  in  favor  of  registration  also 
was  laid  on  the  table.  It  appears  that  previously  Dr..  Cas- 
tleman  had  been  appointed  to  confer  with  the  chancellor 
of  the  University  of  W'isconsin  on  the  subject  of  organizing 
a  medical  department  in  the  university.  At  this  meeting 
he  reported  adversely  to  such  a  move.  This  is  the  first 
record  there  is  of  what  became  a  more  or  less  perennial 
question. 

How  difficult  it  was  to  acquire  information  in  a  territorv' 
so  new  is  evinced  by  the  following : 


6o8  HENRY     BAIRD     FAVILL 

A  committee  which  had  been  appointed,  consisting  of 
one  physician  from  each  county  as  far  as  could  be  done,  to 
report  the  names  and  residence  of  all  practitioners  of  medi- 
cine and' surgery  in  the  State,  with  a  view  to  determining 
their  various  merits,  reports  that  no  reliable  information 
could  be  obtained. 

For  a  period  of  years  after  1850,  the  meetings  appear 
to  have  been  meagerty  attended;  frequently  the  chronicle 
being  that  there  was  not  a  quorum.  In  1854  a  constitution 
was  adopted  and  the  following  were  made  permanent  mem- 
bers: Brisbance,  Blood,  Favill,  Wright,  Head,  Ayers, 
Brown,  Ladd,  Van  Dusen,  Gray,  Hoyt,  and  Pease.  In  this 
year  also  the  code  of  ethics  of  the  American  Medical  Asso- 
ciation was  adopted. 

In  1856  a  resolution  was  adopted  appointing  a  committee 
to  memorialize  the  legislature  on  the  subject  of  building  a 
State  hospital  for  the  insane. 

At  the  breaking  out  of  the  war  of  the  rebellion,  the  society 
practically  died.  Most  of  the  members  went  into  the  ser- 
vice and  no  meetings  were  held.  The  record  of  the  med- 
ical men  of  Wisconsin  in  the  army  was  one  preeminently 
honorable.  It  will  not  do  in  this  paper  to  undertake  any 
discussion  on  many  interesting  phases  of  that  period. 

In  1867  a  meeting  was  called  at  Janesville  for  the  purpose 
of  reorganizing  the  society.  In  the  call  for  the  meeting  there 
occurs  this  resume: 

The  memorable  year  1861,  when  Sumter  was  fired  upon  and 
grim  visaged  War  surprised  a  peaceful  nation  devoted  to  the 
Arts  and  Sciences,  and  broke  up  so  many  honored  associations, 
was  not  less  severe  upon  our  State  Medical  Society  than  upon 
others.  1861  was  the  last  time  it  convened.  Before  the  year 
rolled  around  many  of  its  active  members  had  their  names  en- 
rolled in  the  Grand  Army  of  the  Republic,  some  of  whom  are  now  • 
numbered  among  our  fallen  heroes.  Our  secretary,  the  brave, 
able,  and  indefatigable  Pease,  is  among  the  number.  During 
all  these  years  of  weary  war,  the  public  mind  was  so  engrossed 


M  I  S  C  E  I.  I.  A  N  i:  C)  U  S  609 

with  the  national  calamity,  tli.ii  it  was  not  deemed  practicable 
to  attempt  any  meeting.  With  llie  nation  at  peace  again,  the 
surviving  mcml)crs  of  the  Society  one  by  one  turned  their  thoughts 
to  their  lionorcd  Association.  , 

In  alxnit  i.Syi,  Dr.  Rcovc  of  Applcton  became  secretary 
of  the  society.     He  makes  this  summary: 

The  history  of  the  Wisconsin  State  Medical  Society  seems 
naturally  to  divide  itself  into  three  distinct  periods,  and  the  secre- 
tary in  preparing  a  list  of  its  members  from  its  organization  as 
directed  has  thought  it  best  for  the  sake  of  clearness  to  divide 
the  list  into  three  several  parts  in  accordance  with  the  epochs 
of  its  history.  For  the  list  given  below  we  are  indebted  to  Dr. 
Van  Dusen. 

The  Medical  Society  of  the  Territory  of  Wisconsin  was  organ- 
ized in  1842  by  the  authority  of  the  territorial  legislature.  It 
was  modeled  especially  as  to  membership  after  the  charter  organ- 
izing the  Medical  Society  of  the  State  of  New  York,  being  com- 
posed of  permanent  members,  only  two  of  whom  could  be  elected 
annually,  and  of  delegates  from  county  and  local  societies  which 
were  entitled  to  send  to  it  in  proportion  of  one-fifth  of  their 
membership.  These  delegates  were  entitled  to  all  the  privileges 
of  permanent  members  during  the  time  for  which  they  were 
elected.  The  society  was  thus  sustained  until  1854.  Its  name 
in  the  meantime,  Wisconsin  having  become  a  State,  had  been 
changed  to  the  Medical  Society  of  the  State  of  Wisconsin,  when 
by  act  of  legislature  the  resolution  regarding  the  members  who 
could  be  elected  to  permanent  membership  was  removed.  Up 
to  that  time  no  record  of  members  is  to  be  found  and  all  records 
prior  to  1847  are  lost. 

From  1870  on,  the  progress  of  medical  affairs  was  uni- 
form and  thrifty.  There  has  been  no  time  from  then  until 
now  when  the  State  organization  has  not  been  well  managed 
and  influential. 

Departing  now  from  these  footprints  of  organization  life 
to  something  of  a  bird's-eye  view  of  the  whole  situation,  I 
am  disposed  to  indulge  my  fanc}^  somewhat.  As  I  picture 
21 


6io  HENRY     BAIRD     FAVILL 

those  old  days  they  seem  to  me,  as  I  have  before  stated, 
a  time  of  great  moral  quality  and  mental  strength.  I 
think  this  would  be  the  predominating  characteristic  of 
that  period. 

The  period  beginning  with  1880  must  be  regarded  in 
medical  matters  as  the  renaissance.  The  demonstration  of 
the  germ  theory  of  disease  and  the  enormous  advance  and 
readjustment  incident  thereto,  as  a  history  in  itself,  is  to 
many  of  us  very  familiar,  but  before  this  happened  there 
began  to  spring  up  in  Wisconsin  a  faint  light,  developing 
later  into  a  brilliant  flame,  which  I  believe  to  have  had  a 
more  signal  influence  upon  the  scientific  advancement  of 
the  medical  profession  in  Wisconsin  than  anything  that 
ever  happened.  When  I  was  a  young  boy,  perhaps  fourteen 
or  fifteen  years  of  age,  I  remember  distinctly  hearing  my 
father  discuss  with  his  colleagues  the  remarkable  ability 
shown  by  a  young  physician  who  had  read  a  paper  at  the 
State  Medical  Meeting.  The  name  of  this  young  man, 
then  practically  unknown,  was  Nicholas  Senn.  From  that 
day  until  long  after  he  left  Wisconsin  he  never  failed  to  put 
the  impress  of  his  genius  upon  the  medical  profession  of 
Wisconsin.  His  scientific  spirit,  his  thirst  for  knowledge, 
his  wonderful  sagacity,  his  phenomenal  endurance,  his 
inspiring  enthusiasm  combined  to  make  him  the  greatest 
teacher,  of  the  greatest  scientific  influence,  that  the  State 
has  ever  known.  That  the  State  has  developed  quantities 
of  able  men,  teachers,  practical  men,  and  leaders  since  that 
time  is,  of  course,  true,  but  no  one  who  is  in  position  to  have 
seen  the  unfolding  of  scientific  medicine,  as  it  gradually 
revealed  Nicholas  Senn  and  his  school,  could  venture  to 
differ  with  my  estimate  of  his  importance. 

Two  phases  of  medical  development  are  worthy  of  men- 
tion at  this  point. 

Wisconsin  early  acquired  a  strong  conception  as  to 
public  health  matters,  and  in.  18 76  there  was  appointed  the 
first  State  Board  of  Health.     The  members  of  the  original 


M  I  s  c  i<;  r.  r.  A  N  i<:  o  u  s  61 1 

board  were  E.  L.  Oriffin  of  V()]](\  <]\]  I^ac,  who  was  chosen 
president;  Jas.  'J\  Reeve  of  Ai)])leton,  who  was  for  many 
years  secretary;  and  John  Favill  of  Madison,  Solon  Marks 
of  Milwaukee,  James  Bintliff  of  Janesville,  who  was  not  a 
physician,  H.  B.  Strong  of  Beloit,  and  O.  G.  Seldon  of 
Tomah.  It  is  impossible  to  trace  the  steps  of  development 
of  the  State  Board  of  Health,  but  it  is  fully  worth  while 
to  call  attention  to  the  fact  that  no  vState  board  of  health  is 
stronger  or  more  vital  than  the  present  board  in  Wisconsin. 
What  is  known  as  the  "Wisconsin  idea"  in  legislation 
and  administration  has  extended  in  full  to  its  State  Board 
of  Health,  and  a  careful  study  of  that  situation  will  show  an 
enlightenment  and  effectiveness  that  is  fully  abreast  of  the 
best  of  the  advanced  things  of  Wisconsin  public  affairs. 

The  other  item  is  medical  education  in  Wisconsin.  The 
first  flash  of  that  which  has  been  previously  noted  as  crop- 
ping out  from  time  to  time  in  the  suggestion  for  a  medical 
department  in  the  university,  is  described  in  the  following 
words  written  by  Dr.  B.  F.  Dodson  of  Berlin,  the  uncle  of 
John  M.  Dodson  of  our  society.  Speaking  of  the  profes- 
sion of  medicine  in  the  early  days,  he  writes: 

I  went  into  Dr.  C.  B.  Chapman's  family,  December  17,  1851, 
and  remained  until  November,  1S53.  Living  in  the  place  besides 
Dr.  Chapman  were  Drs.  Favill,  Ward,  and  Gray,  all  in  active 
practice.  At  Cottage  Grove  were  Drs.  Rogers  and  Crane.  Dr. 
Rowley,  I  think,  lived  at  Middleton.  In  the  Spring  of  '52  there 
was  added  Dr.  Bowen,  who  came  from  Rochester,  N.  Y.  At 
this  time  Dr.  Chapman  was  giving  a  good  deal  of  time  to  instruct- 
ing students,  having  a  couple  of  rooms  for  that  piirpose  on  the 
corner  of  State  Street,  in  which  the  class  had  an  opportunitv  to 
do  some  dissecting,  some  friendly  physicians  outside  furnishing 
the  dissecting  material.  During  the  summer  months,  his  aim 
was  to  hold  weekly  recitations  in  anatomy  and  physiology.  As 
most  of  the  class  was  made  up  of  persons  other\\'ise  engaged,  they 
could  not  recite  ever}^  day.  I  may  mention  the  names  of  some 
of  the  class,  though  I  can  not  give  the  given  names:  Wilcox,  after- 
wards member  of  the  assembly;    G.  R.  Tajdor,  who  afterward 


6i2  HENRY     BAIRD     FA  V  ILL 

practiced  at  Waupaca;  Prof.  Enos,  principal  of  the  Madison 
School;  Holt,  who  afterward  practiced  at  Little  Falls,  N.  Y.; 
Boswell  and  Crandall,  two  university  students  who  returned  to 
Canada  in  '53,  and  others  — as  well  as  m3'self. 

Because  of  the  meagerness  of  the  clinical  material  avail- 
able in  the  State,  and  particularly  at  Madison,  it  was  never 
deemed  advisable  to  start  a  full  medical  college  during  the 
last  half  of  the  last  century.  With  the  further  evolution 
of  university  importance  came  the  natural  demand  for  a 
department  of  medicine,  and  in  1907  there  was  organized 
at  the  University  of  W^isconsin  a  department  of  medicine, 
which  covered  a  course  of  two  years,  consisting  of  the  first 
half  of  a  modern  medical  course.  From  the  very  beginning 
this  has  been  a  department  of  the  very  highest  excellence. 
Before  this  department  was  fully  organized,  the  University 
had  been  giving  what  was  known  as  a  pre-medical  course, 
which  was  universally  acknowledged  to  be  of  the  best  qual- 
ity as  a  preparatory  work  for  the  medical  profession.  It 
would  be  impossible  to  deal  justly  with  all  of  the  factors 
that  entered  into  its  latest  development.  Suffice  it  to  say 
at  this  moment  that  there  is  not  in  the  country  to-day  a 
better  course  covering  the  first  two  years  offered  than  that 
at  the  University  of  Wisconsin.  Starting  out  with  the 
avowed  purpose  of  confining  the  course  to  non-clinical 
studies,  it  has  been  unhampered  in  its  scientific  develop- 
ment. As  medical  men  there  is  nothing  in  the  history  of 
the  State  to  which  we  can  point  with  greater  pride  and  sat- 
isfaction than  the  present  status  of  its  medical  instruction. 

All  in  all,  the  progress  of  the  profession  from  its  pioneer 
days  has  been  a  consistent  and  logical  and  thoroughly  strong 
development. 

In  sketching  this  last  so  extremely  superficially  as  I  have 
done,  I  am  aware  that  I  have  been  able  to  do  nothing  but 
suggest  the  characteristics  of  the  State  rather  than  enter 
into  its  history. 

In  looking  into  the  matter,  such  a  mass  of  material  is 


MISCELLANEOUS  613 

available  that  is  of  interest,  and  important  from  the  medical 
standpoint,  that  I  have  come  to  see  but  one  possibility  for 
a  paper  of  this  character,  namely,  that  it  should  be  a  run- 
ning sketch  more  or  less  acquired  by  personal  familiarity 
and  reminiscence.  In  so  doing  I  have  had  to  pass  by 
scores  of  men  of  strength  and  significance,  whom  I  should 
delight  to  describe  and  characterize,  because  of  their  in- 
trinsic worth.  Any  such  effort,  however,  must  be  reserved 
for  a  more  serious  lal^or. 

I  have  already  encroached  upon  your  time  as  fully  as  I 
ought  and  I  shall  be  more  than  repaid  if  I  have  conveyed  to 
you  the  feeling  which  I  have,  and  which  is  shared  by  my  col- 
leagues of  Wisconsin,  of  loyalty,  admiration,  and  love  for 
the  old  guard  and  enthusiasm  and  approval  and  possibly 
a  little  envy  for  the  new. 


6l4  HENRY      BAIRD     FA  V  ILL 


Delivered,  to  the  Graduating  Class  of  St.  Luke's  Hospital  Training  School 

for  Nurses,  June  20,  1912. 
Printed,  The  AlumncB,  September,  1912. 

TRIFLES   AND   IDEALS 

WHEN  I  am  invited,  as  I  have  been  once  before,  by 
the  nurses  of  the  graduating  class  to  address  them 
upon  this  occasion,  which  I  hope  is  auspicious  and 
which  I  am  very  sure  is  significant,  I  find  my  gratification 
gradually  merging  into  a  sense  of  responsibility. 

I  am  quite  sure  that  no  one  intended  that  I  should  deliver 
a  sermon  or  even  deeply  moralize  in  connection  with  these 
exercises.  Nevertheless,  I  find  myself  becoming  serious 
and  thoughtful,  as  I  think  the  matter  over,  and  as  I  ana- 
lyze it  I  see  that  beneath  it  lies  a  consciousness  of  relation- 
ship to  these  young  women,  which  is  very  much  deeper 
than  casual  and  more  responsible  than  merely  friendly. 

Perhaps  it  is  natural  to  those  who  have  attained  con- 
siderable years  to  look  over  the  field  of  human  relations 
in  a  mood  that  is  contemplative,  and  with  a  sense  of  im- 
portance as  to  one's  view  that  would  not  be  natural  to 
those  who  are  upon  the  threshold  of  a  career. 

I  am  about  to  take  a  text  for  the  purpose  of  examining 
it  to  see  whether  or  not  it  is  sound.  I  do  not  know  whom 
I  quote  in  this  stanza: 

A  young  Apollo,   golden-haired,   stands  eager  on  the 

verge  of  strife, 
Magnificently  unprepared  for  the  long  littleness  of  life. 

The  first  impression  of  that  sentiment  is  unpleasant. 
For  even  though  it  be  not  interpreted  as  cynical,  there  yet 
runs  through  it  a-  note  of  anxiety  and  perhaps  disappoint- 
ment. 

Those  who  have  not  looked  back  upon  the  young  with 
feelings  of  solicitude  as  to  their  course  and  development 


M  I  S  C  K  L  L  A  N  K  O  IJ  S  615 

and  well-being,  ean  hardly  realize  how  the  hearts  of  elders 
ache  to  shield  those  younger  from  much  that  the  world 
has  heaped  upon  themselves,  and  to  guide  them  through 
the  maze  of  blunders,  of  which  life  is  largely  made  up,  in 
such  a  way  as  to  bring  them  greater  happiness  if  possible  or 
at  least  to  lessen  the  enormous  apparent  waste  that  comes 
through  life  lived  in  such  obscurity  of  view  as  to  permit 
the  mistakes  which  life  so  generously  furnishes. 

I  am  very  sure  that  it  is  unsound  to  argue,  as  we  often 
do,  that  everything  must  be  learned  by  experience,  and 
that  that  which  we  of  mature  experience  have  learned  we 
ean  in  no  wise  pass  on.  Clearly  this  is  not  true  with  re- 
gard to  abstract  knowledge.  Why  should  it  be  true  with 
reference  to  that  intricate,  intimate,  and  difficult  field  of 
living  one's  life? 

My  conclusion,  therefore,  is  that  our  method  of  ap- 
proaching knowledge  of  life  differs  from  our  method  of 
approaching  knowledge  of  other  sorts,  and  that  our  con- 
spicuous failure  to  pass  on,  for  the  benefit  of  our  youngers, 
that  which  we  have  learned  is  probably  more  a  matter  of 
method,  than  a  matter  of  essential  possibility.  To  me  the 
fact  appears  to  be  that  knowledge  of  living,  which  means 
not  only  that  which  we  have  gained  by  experience,  but 
that  which  we  derive  out  of  our  philosophic  life,  is  not  set 
forth  with  the  clearness  necessary  to  its  comprehension. 

It  is  obvious  that  for  this  there  is  abundant  reason. 
One  can  not  unfold  all  the  experiences  of  his  life,  expound 
all  the  theories  of  his  philosophy,  nor  attack  the  inner  con- 
sciousness of  his  hearers,  without  opening  up  the  inner 
recesses  of  being  to  an  extent  the  extreme  of  which  would 
be  unthinkable. 

If  one  were  to  array  everything  that  he  might  offer  for 
the  benefit  of  the  younger  generation  as  constituting  the 
best  contribution  to  humanity,  he  would  probably  succeed 
only  in  setting  forth,  no  matter  how  truthfully,  a  bald 
arra^^  of  facts  more  or  less  unpleasant,  entirely  one-sided 


6i6  HENRY     BAIRD     FAVILL 

with  respect  to  moral  value,  and  probably  conveying  no 
accurate  idea  of  the  truth. 

It  is  next  to  impossible  in  language  to  tell  the  whole 
truth;  and  to  undertake  to  set  forth  isolated  facts,  partic- 
ularly the  facts  of  confessional,  the  facts  of  failure,  or  the 
facts  of  discredit,  mthout  at  the  same  time  giving  all  the 
atmosphere  in  which  they  should  be  interpreted,  is  to  pre- 
pare a  picture  under  the  guise  of  truth  which  will  be  in  its 
influence  to  a  large  extent  falsehood. 

It  is  not  likely  that  our  effort  to  pass  on  the  fruits  of 
our  experience  will  be  best  promoted  by  the  analysis  of  the 
detail  of  our  respective  experience.  Yet,  I  return  to  the 
statement  before  made,  that  we  make  no  effort  to  form- 
ulate our  experience  comparable  to  that  which  we  expend 
in  the  formulation  and  transmission  of  abstract  knowledge. 

I  am  convinced  that  one  of  the  factors  in  this  educa- 
tional failure  is  the  fact  that  all  childhood  is  a  period  of 
delusion.  To  some  extent  this  is  inherent  in  the  nature  of 
childhood.  To  some  extent  it  is  a  creation  of  our  way  of 
dealing  with  childhood.  The  child  is  by  nature  imitative. 
He  early  becomes  the  imitator  of  his  elders.  His  aspiration 
is  in  the  direction  of  things  which  he  conceives  to  be  the 
things  of  developed  life.  As  a  baby  he  selects  a  vocation  or 
chooses  heroes  or  writes  a  novel  or  fights  Indians,  with  as 
much  intensity  of  purpose  as  he  ever  will  manifest.  This 
tendency  one  can  neither  criticize  nor  regret.  It  is  the 
channel  of  human  progress.  One  would  not  modify  it  nor 
divert  it.     Do  we  intelligently  and  adequately  utilize  it? 

Beyond  question  we  create  consciously  or  unconsciously 
ideals  for  the  young.  It  is  with  these  ideals  which  the 
mature  set  before  the  young  that  I  wish  to  deal.  Litera- 
ture, art,  history  as  it  is  written,  the  pulpit,  the  press,  and 
the  teacher  all  tend  to  idealize  human  experience. 

The  abstractions  of  truth,  beauty,  virtue,  friendship, 
ambition,  riches,  and  power  are  dominating  notes  in  the 
mental  pabulum  which  is  available  for  the  young. 


MISCELLANICOUS  617 

That  the  essence  of  any  or  all  of  these  has  its  value,  one 
need  not  question.  The  fear  of  destroying  or  defacing  any 
image  which  we  create  and  set  up  as  an  ideal,  inhibits  very 
strongly  any  tendency  which  we  might  otherwise  have  to 
divScuss  the  facts  of  life  freely.  I  submit,  however,  that  any 
image  which  is  not  consistent  with  the  facts  which  must 
be  assembled  for  its  support,  which  must  be  approached 
abashed  with  head  down  and  feet  unsandaled,  is  an  idol, 
not  an  ideal.  Worship  of  the  world  has  always  been  di- 
rected toward  abstractions.  For  the  most  part,  worship 
of  the  world  has  been  without  comfort  or  solace  or  sense  of 
unity.  Fear,  placation,  and  adoration  have  played  their 
part,  but  sympathy  and  oneness  rarely.  To  a  very  large 
extent  the  disappointment  of  life  is  due  to  this  chasm  which 
yawns  between  our  abstractions,  be  they  religious  or  ethical, 
and  our  actual  living  experience.  We  have  created  for  our- 
selves, out  of  our  imaginative  nature,  dreams  of  magnifi- 
cence, and  we  have  had  created  for  us,  by  our  elders, 
standards  of  thought,  philosophy,  and  conduct  to  which  our 
natures  variously  respond,  but  on  the  whole  towards  which 
we  reach  out  with  hope  and  confidence  and  exaggerated  faith. 

Hence  the  picture  which  I  set  forth  at  the  beginning, 

A  young  Apollo,  golden-haired,  stands  eager  on  the 
verge  of  strife. 

If  one  were  to  abruptly  stop  the  discussion  at  that  point 
he  would  fairly  portray  our  attitude  as  parents  and  teachers 
toward  youth,  and  its  chances  in  life.  This  is  what  we  have 
said,  that  is  what  we  have  done,  and  even  what  we  have 
permitted  ourselves  to  think,  as  we  have  adjusted  ourselves 
to  our  children,  and  yet  there  is  not  one  of  us  but  knows 
that  there  is  a  ring  of  untruth,  about  it:  and  for  my  part 
I  believe  that  it  is  reaction  to  that  untruth,  fulty  as  much 
as  the  realization  of  the  facts,  that  permits  so  much  un- 
happiness  in  the  development  of  the  average  life. 

Disappointment  is  rarely  simply  deprivation.     Almost 


6l8  HENRY      BAIRD     FAVILL 

always  comes  into  it  the  element  of  deception.  One  has 
hardly  set  his  heart  upon  a  thing,  strongly  enough  to  suffer 
much  disappointment,  who  has  not  been  led  to  feel  con- 
fident that  it  is  a  legitimate  expectation.  If  it  should 
prove  in  the  end  that  his  hypothesis  is  untrue,  either  he 
will  discredit  his  teacher,  repudiate  his  ideals,  or  embitter 
his  life  with  self-reproach. 

If  the  comment  be  made  that  this  is  a  sad  picture,  I 
ask  you  in  all  fairness  whether  it  is  one  bit  sadder  than 
every  life  at  some  point,  and  than  many  lives  throughout? 
It  is  unwillingness  to  look  at  things  as  they  are  that  makes 
us  the  playthings  of  every  puff  of  wind,  and  it  is  only 
by  looking  at  things  as  they  are  that  we  can  hope  to  find  a 
sound  philosophy  and  a  better  method. 

My  general  criticism  of  the  way  we  live  our  lives  is  not 
a  criticism  of  our  ideals.  I  criticize  our  relation  to  our 
ideals.  In  a  word,  we  are  too  far  separated  from  them. 
We  have  been  enjoined  to  "hitch  our  wagon  to  a  star," 
when  we  ought  to  use  it  for  a  headlight.  The  only  way  in 
which  we  can  get  pleasure  out  of  our  path  through  life  is 
through  its  illumination. 

It  is  true  we  may  walk  in  the  dark,  we  may  keep  the 
path  and  we  may  not  even  stumble,  but  the  joy  of  the  way 
can  never  be  there.  Only  to  the  fanatic  can  the  shrine  at 
the  end  of  the  way  be  life's  sole  benediction.  It  is  the 
quality  of  the  means  and  not  the  magnificence  of  the  end 
that  give  character  to  any  life.  It  follows,  therefore,  that 
our  ideals  should  be  distributed  rather  than  concentrated; 
that  we  should  clothe  with  its  appropriate  measure  of  ideal 
every  experience  in  life.  If  that  idea  be  developed,  one 
sees  unfolded  before  him  a  wonderful  dream,  and  the  thing 
that  bears  in  upon  him  almost  oppressively,  until  he  learns 
to  use  it,  is  the  consciousness  that  there  is  no  such  thing 
as  a  trifle.  Not  only  is  it  necessary  to  realize  that  in 
human  affairs  there  are  no  trifles,  but  it  is  also  necessary 
to  put  upon  small  things  their  true  value. 


M  I  SCE  J.  L  A  N  lOO  IJ  S  619 

The  tendency  of  the  day  is  toward  cxjjansion,  not  only 
of  opportunity,  l)ut  as  to  standards  of  hvin^.  We  are  prone 
to  complain  of  the  indulgences  which  people  permit  them- 
selves in  materitd  things  and  in  social  relations.  The  im- 
plication in  the  indictment  is  that  luxury  and  self-indulgence 
is  the  deteriorating  and  damaging  influence.  There  is  no 
doubt  from  many  points  of  view  that  this  is  true,  but  for 
our  present  purpose  I  wish  to  look  upon  the  trend  of  the 
times  with  resjject  to  another  matter. 

The  whole  tendency  of  the  day,  in  people  who  have  any 
possible  margin  of  choice,  is  toward  the  elaborate  and  away 
from  small  things.  Whether  this  be  in  personal  adorn- 
ment, sport,  or  social  activities,  the  drift  is  unmistakable. 
To  me,  there  is  in  this  movement  a  great  human  loss.  By 
as  much  as  pleasure  and  satisfaction  is  dependent  upon 
magnitude  and  complexity,  by  so  much  are  the  opportuni- 
ties for  satisfaction  in  life  diminished.  The  application  of 
this  is  much  broader  than  the  mere  question  of  pleasure. 
It  is  as  deeply  related  to  what  one  gives  as  to  what  one 
receives.  The  day  when  the  conventional  gifts  of  the 
holidays  became  matters  of  expense  and  burden  rather  than 
tokens  of  kindly  thought,  sounded  the  death  knell  of  the 
institution.  The  day  when  one's  social  offices  departed 
from  simple  lines  of  hospitality  and  launched  upon  the  sea 
of  "entertainment, "  killed  by  ninety  per  cent  the  possi- 
bilities of  wholesome  human  intercourse. 

All  these  are  temporary  phases  of  our  social  develop- 
ment and  are  neither  hopeless  nor  presumably  very  serious, 
because  things  do  swing  back,  but  they  serve  to  illustrate 
and  emphasize  my  point  that  to  lose  one's  appreciation  for 
small  events,  occupations,  or  offices  of  life,  is  to  be  deprived 
of  the  very  great  preponderance  of  its  possibilities. 

As  regards  one's  internal  life,  the  same  general  consider- 
ations apply.  A  friend  of  mine,  a  verA^  able  physician  and 
profound  philosopher,  once  said  to  me  seriously,  "Do  you 
attach  much  importance  to  health  ? ' '     My  repl}'  was,  ' '  From 


620  HENRY      B  A  I  R  D     F  A  V  I  L  L 

the  standpoint  of  an  asset  which  one  can  use  to 
advantage,  or  if  necessary  abuse  with  impunity,  I  think 
I  do,  but  the  great  value  that  I  attach  to  having  health  is 
the  process  by  which  one  has  it."  Up  to  a  certain  point, 
and  up  to  a  certain  age,  health  is  reasonably  automatic,  and 
not  perhaps  a  matter  of  much  conscious  or  internal  effort, 
but  beyond  that  point  health  can  only  be  maintained  by 
conscious  and  intelligent  management  of  one's  life. 

Under  prevailing  social  conditions,  the  maintenance  of 
maximum  health  is  a  matter  of  discipline.  Not  only  does 
it  involve  intelligent  decision  as  to  conduct,  but  it  involves 
thorough  mastery  of  one's  opposing  impulses,  and  for  the 
most  part  unceasing  vigilance.  The  person  who  has  adopted 
an  ideal  of  health  as  a  fixed  ethical  demand,  has  gone  far. 
He  who  consistently  will  live  to  determine  that  result  has 
become  not  only  powerful  but  free.  There  is  no  freedom 
except  that  which  comes  through  thorough  self-possession, 
and  the  way  to  this  in  matters  of  health  is  never  easy,  yet 
most  of  the  points  which  are  crucial  are  matters  which  are 
generally  regarded  as  too  trifling  for  serious  consideration. 

The  quest  for  health  perhaps  illustrates  better  than 
anything  the  importance  of  incorporating  our  ideal  into 
daily  life.  In  no  department  of  human  experience  is  it 
more  true  that  in  order  ever  to  reach  the  end  desired, 
every  quality  of  the  end  must  be  present  in  our  acts  from 
the  beginning.  It  is  conceivable  that  a  man  .can  say 
that  he  will  be  dishonest  until  sixty  and  absolutely  upright 
from  then  until  seventy,  or  that  he  will  be  irreligious  until 
old  and  religious  at  the  end,  but  experience  shows  beyond 
any  doubt  that  in  order  ever  to  have  physical  well-being 
tow^ard  the  end  of  life,  one  must  have  adhered  to  sound 
principles  from  the  beginning. 

If  this  is  true  in  these  simple,  commonplace,  rather 
obvious  phases  of  human  experience,  how  much  more  is  it 
true  in  the  complicated  relations  of  developed  social  ex- 
istence ?      If  one  is  to  find  in  his  single  personal   contact 


M  I  SC  ]<:  L  L  A  N  K()  U  S  621 

such  importance  in  small  detail,  how  much  more  is  it  true 
when  the  possibilities  of  reaction  are  multiplied  in  terms 
of  society? 

Have  you  ever  stopy)e(l  to  consider  what  things  in  your 
life  experience  have  made  the  most  lasting  impression  upon 
you?  Do  you  realize  they  are  the  things  which  are  not 
taught  you  nor  told  you  with  any  intent  to  instruct,  hut 
things  of  the  most  casual  accidental  nature?  If  you  re- 
flect upon  it,  you  will  come  to  see  that  the  small  things 
which  you  do  or  say  or  encounter  in  life  are  perhaps  the 
most  crucial,  and  if  out  of  that  reflection  you  gain  no  pre- 
cept or  rule  as  to  what  you  shall  do,  you  at  least  will  gain  a 
recognition  of  the  importance  of  not  misrepresenting  your- 
self by  thoughtless  or  deliberately  unfaithful  conduct. 

As  one  reflects  upon  it,  one  comes  to  appreciate  the 
influence  of  casual  relations  upon  all  things  which  one 
touches.  The  more  deeply  one  takes  that  to  heart,  the 
stronger  is  the  feeling  of  obligation  to  determine  and  main- 
tain an  ethical  standard  throughout  the  infinitely  complex 
relationships  of  life. 

Given  this  point  of  view,  no  longer  can  life  be  regarded 
as  made  up  of  littleness.  Every  day,  every  hour,  every 
turn,  there  is  a  significance  and  importance  to  conduct 
which  dignifies  it  beyond  expression. 

Particularly  is  this  true  with  reference  to  relationships 
which  may  be  regarded  as  of  unequal  footing.  The  at- 
titude of  the  rich  toward  the  poor,  the  powerful  toward 
the  weak,  the  steady  toward  the  vacillating,  afford  inten- 
sification of  this  point.  From  this  point  of  view,  those 
are  particularly  fortunate  whose  opportunity  or  vocation 
in  life  puts  them  in  position  to  think  or  sa}^  or  do  the 
things  of  deeper  value,  with  respect  to  their  less  fortunate 
fellows. 

Has  an3^one  much  larger  opportunity  in  this  regard 
than  the  competent  nurse?  I  have  alwa^^s  regarded  this 
vocation  as  of  peculiar  importance  in  the  human  fabric. 


622  HENRY      BAIRD     FAVILL 

The  nurse  who  has  had  adequate  training  and  faithfully 
availed  herself  thereof,  is,  in  the  ranks  of  men,  an  expert. 

In  breadth  of  experience,  technical  skill,  and  cultivated 
judgment,  she  stands  out  from  the  rank  and  file  of  people 
as  of  peculiar  value  and  unusual  importance  with  regard 
to  matters  of  the  deepest  human  import.  If  one  were  not 
so  accustomed  to  it,  he  would  marvel  at  the  absolute  faith 
that  is  pinned  upon  a  mere  girl  just  because  she  is  accredited 
such  an  expert. 

The  most  important  consideration  which  human  happi- 
ness holds  is  entrusted  to  this  girl  without  question  and 
without  analysis.  Yet  such  analysis  would  show  that  this 
confidence  is  based  upon  a  belief,  first  in  her  technical 
ability,  and  second  in  her  conscience.  Either  being  lacking, 
the  whole  structure  tumbles;  if  she  is  not  trained  she  can 
not  be  trustworthy;  if  she  is  not  conscientious  she  won't 
be  trustworthy,  and  yet  without  a  thought  we  place  the 
issue  of  life  and  death  unhesitatingly  upon  her  young  but 
competent  shoulders. 

Is  there  not  in  this  picture  untold  inspiration?  Does 
it  not  deprive  drudgery  of  its  ache  and  routine  of  its  irk- 
someness?  Does  it  not,  above  all,  make  the  idea  of  trifles 
an  absurdity?  Does  it  not  serve  to  emphasize  the  proverb, 
that,  "A  chain  is  as  strong  as  its  weakest  link"?  Does  it 
not  make  the  weakest  link  a  subject  of  deep  and  perhaps 
enthusiastic  effort? 

And  3^et,  it  is  not  with  reference  to  the  technical  skill 
and  scientific  faithfulness  of  the  nurse  that  my  mind  is 
most  directed  in  this  connection.  I  have  much  more  in 
mind  her  opportunity  in  the  development  of  her  relation- 
ships. Who  is  there  that  is  closer  to  the  hearts  of  the  suffer- 
ing? Who  is  there  more  fitted  to  see  clearly  the  threads 
which  are  running  through  the  warp  and  woof  of  human 
experience,  or  has  more  opportunity  to  put  them  straight? 

It  is  not  true  that  the  lives  of  all  nurses  are  benedictions. 
It  is  true  that  every  nurse  has  the  opportunity  to  be  a 


M  I  S  (   E  1.  L  A  N  I<:  O  U  S  623 

ministering  angel.  I  would  not  limit  this  to  the  mere  ques- 
tion of  soothing  the  troubled  sufferer  or  waiting  upon  the 
querulous  invalid.  The  opportunity  is  much  larger  than 
that;  opportunity  to  influence,  [)erhaps  by  word,  more  often 
by  deed,  and  always  by  s])irit,  those  who  are  through  mis- 
fortune put  u])on  a  footing  unstable,  unhappy,  and  often 
untrue. 

To  come  into  a  situation  thus  demoralized,  strong,  clear, 
and  courageous,  is  to  enter  upon  a  relationship  in  life  with 
the  maximum  opportunity  to  accomplish  great  things,  but 
an  opportunity  which,  to  fully  grasjj,  one  must  be  great. 
No  nurse  can  reach  the  fullness  of  her  power  and  influence 
without  conscious  and  intentional  cultivation.  What  she 
can  do  with  herself  will  determine  what  she  can  do  in  the 
world. 

People  are  variously  endowed,  but  very  meager  endow- 
ments developed  under  a  lofty  spirit  will  go  far  beyond 
the  most  brilliant  talents  smothered  by  indifference  and  self- 
esteem. 

As  we  get  on  in  years,  life  is  prone  to  pass  before  us  in 
review,  and  everyone  sooner  or  later  comes  to  a  time  when 
he  measures  up  the  past,  weighs  the  experience  of  life,  and 
in  some  more  or  less  direct  formulation  decides  whether  life 
has  been  a  big  thing  or  a  little  thing.  Is  it  not  perfectly 
obvious  that  one's  decision  must  be  determined  ver>^  largely 
by  the  sum  total  of  one's  activities?  Whether  it  can  be 
plain  to  you  or  not,  I  have  no  hesitation  in  making  the 
assertion  that  the  conclusion  upon  this  question  wall  turn 
almost  solely  upon  the  importance  that  one  has  attached  to 
the  small  events  and  more  or  less  trivial  contact  of  every- 
day experience. 

The  consciousness  of  having  performed,  even  though 
inadequately,  at  least  with  fidelity,  the  details  of  life,  will 
be  vital.  To  be  sure,  those  who  have  not  done  it  for  the 
most  part  will  not  know  it,  but  to  those  who  have  done  it, 
life  will  reveal  itself  very  dift'erently  than  to  those  who  have 


624  HENRY      B  A  I  R  D     F  A  y  I  L  L 

not.  Upon  this  very  point  will  turn  one's  attitude  of  mind 
as  to  the  valuation  of  life. 

He  who  at  the  end  shall  look  back  seeing  clearly  the 
littlenesses  in  life  and  on  the  whole  shall  despise  them  and 
it,  is  one  who  has  signally  failed  in  measuring  up  even  to 
this  littleness. 

He  who  looks  back  upon  this  picture  with  sympathy 
and  appreciation  and  approval,  has  at  least  been  big  enough 
for  his  opportunities. 

He  who  can  possibly  bring  into  focus  and  clear  vision, 
those  proportions  and  relationships,  in  advance,  and  stead- 
fastly and  contentedly  walk  to  them  and  through  them, 
earnest  and  faithful  and  courageous,  is  invulnerable.  To 
such  an  one  the  picture  of  eager  youth,  facing  the  realities 
of  life,  will  not  seem  pathetic  or  futile. 

For  all  youth  one  can  but  ask  that  their  instinct  to  do 
the  thing  next  at  hand  faithfully,  may  be  sufficiently  strong 
to  carry  them  safely  to  the  point  where  they  finally  realize 
the  magnitude  of  life's  opportunities. 


M  1  SC  EL  J.  A  N  ICO  U  S  625 


Delivered  to  the  OrufliialinK  Class  of  the  Francis  W.  Parker  School, 
June  21,   1912.     (Edited  by  J.  F.) 

UNSELFISHNESS 

ONli^  of  the  (U'cpc'sl  iin])rcssions  I  ever  remember  re- 
ceiving' was  from  tJic  first  morning  exercise  that  I 
attended  at  the  old  Normal  vSchool  during  the  days  of 
Colonel  Parker.  At  that  time  I  saw  perhaps  more  clearly 
than  I  ever  saw  —  and  I  was  then  not  too  old  to  learn  —  the 
enormous  value  of  early  practice  in  public  speaking.  The 
memory  of  the  spirit  of  that  morning  exercise  is  most  vivid. 
There  I  learned,  if  I  had  never  learned  before,  that  it  was 
possible  for  anybody,  the  youngest  child  in  the  school  and 
the  most  mature  and  conscious,  to  get  upon  his  feet  and 
say  what  he  thought,  without  preparation,  without  trepi- 
dation, and  without  disturbance.  And  I  really  think  that 
it  has  had  great  influence,  even  in  my  mature  years,  in  my 
speaking.  I  think  there  is  perhaps  no  class  of  people  before 
whom  I  could  come  more  willingly,  or  indeed  be  more 
anxious  to  come,  without  any  particular  preparation  for 
what  I  have  to  say,  to  set  forth  the  few  thoughts  that 
have  come  to  me  in  connection  with  this  occasion.  There 
is  only  one  objection  to  this  sort  of  thing,  and  that  is 
that  one  never  quite  knows  when  one  is  done,  and  that 
is  why  I  have  asked  you  to  sit  down,  as  you  ma^^  grow 
very  weary. 

We  are  engaged  in  this  community  now,  ver^^  deeply  en- 
gaged, in  fact  involved,  in  what  is  going  on  in  the  National 
Convention.  There  goes  on  a  struggle  which  it  is  quite 
possible  history  may  refer  to  as  a  titanic  struggle.  To  our 
current  view  it  looks  very  much  like  the  fight  of  the  Kil- 
kenny cats,  mth  all  those  types  of  personal  feeling  —  asper- 
ity, rancour,  vindictiveness,  and  perhaps  more  malevolent 
feelings  —  that  come  into  human  aft'airs,  in  what  should  be 
a  great  serious  gathering  of  our  people.     Underneath  it  all 


626  HENRY      BAIRD     FA  V  ILL 

there  is  a  meaning,  there  is  a  reason  which  it  behooves  us  to 
see,  and  not  allow  ourselves  to  be  carried  away  into  abstrac- 
tions of  doubt  as  to  the  methods  and  acts  of  the  political 
parties  involved  in  that  performance.  Underneath  this 
thing  is  a  great  social  consciousness.  The  struggle,  if  one 
could  put  it  into  a  brief  word,  is  between  what  perhaps  are 
known  as  Progressives  and  what  perhaps  should  be  known 
as  Non-Progressives,  although  that  does  not  very  clearly 
state  the  facts.  Nevertheless  you  know  what  I  mean. 
The  Progressives  have  a  theory  underneath  their  activities 
which  is  distinctly  a  theory  of  democracy,  a  theory  of  class 
consciousness,  based  upon  the  general  proposition  that  it  is 
the  business  of  the  thinking  people  of  the  world  to  undertake 
to  mitigate  or  improve  the  general  living  conditions  of  the 
world.  Underneath  their  activity  is  the  idea  of  the  present 
inequality  of  hfe,  the  inequality  of  opportunity,  of  endow- 
ment, of  the  general  material  things  of  life.  And  these 
people  have  set  about  to  see  if  they  cannot  do  something  in 
connection  with  our  organic  government  to  better  this  state 
of  affairs,  to  bring  out  of  the  present  unsatisfactory  state 
something  which  is  more  in  keeping  with  the  true  spiritual 
as  well  as  material  welfare  of  the  people.  That  is  what  is 
beneath  the  activities  of  this  progressive  movement.  On 
the  other  side  —  but  I  really  hesitate  to  call  them  Non- 
Progressives,  because  that  is  a  word  which  is  only  fit  to  use 
as  a  distinguishing  word  and  is  not  at  all  distinctive — is  a 
class  of  people  who,  admitting  all  the  facts  as  stated,  never- 
theless are  at  variance  with  the  Progressive  Party  as  to  what 
ought  to  be  done,  as  to  how  to  manage  it.  And  so  these 
two  classes  of  people  come  into  a  great  clash,  which  has 
allowed  itself  to  be  terribly  smirched  with  all  the  failings  and 
weaknesses  that  men  and  women  are  prone  to,  and  we  are 
very  hkely  to  lose  sight  of  the  fact  that  there  is  going  on 
there  just  that  kind  of  a  moral  struggle  because  it  has  be- 
come more  or  less  lost  in  the  superficial  weaknesses  of  hu  - 
manity.     And  it  is  this  moral  struggle  about  the  conditions 


MISCELLANEOUS  627 

in  question  which  has  led  to  any  siifh  moral  ujjrisinj^  and 
moral  reaction. 

It  is  a  little  difficult  to  put  into  a  few  words,  and  yet  I 
need  to  call  your  attention  to  the  fact  that  the  crying  charac- 
teristic of  civilization  to-day  is  inequality.  The  thing  that 
has  put  this  great  revulsion  into  our  minds  about  the  value 
of  civilization,  about  what  it  has  accomplished,  about  what 
it  can  accomplish,  is  the  fact  that  there  is  such  inequality 
in  the  general  distribution  of  the  things  that  are  worth 
while  —  that  some  people  are  starving  physically,  mentally, 
and  morally,  while  others  have  a  surfeit.  *  And  this  thing 
has  gone  on  from  time  immemorial,  and  is  going  on  now, 
and  perhaps  getting  worse  rather  than  better,  in  certain 
respects,  and  the  question  is.  How  has  it  come  about? 
Well,  now,  it  has  come  about  naturally  enough ;  it  has  come 
about  by  reason  of  what  is  known  as  special  privilege;  it 
has  come  about  by  one  class  of  people  being  stronger  than 
another,  by  one  class  of  people  being  more  intelligent  or 
more  aggressive  —  or  more  something  —  which  has  led  them 
into  a  position  where  they  could  get  from  the  great  masses 
of  people  special  privilege.  Under  special  privilege  has 
grown  up  this  state  which  has  resulted  in  inequality,  so  that 
millions  and  millions  of  the  world  are  toiling  unduly  and 
unfairly  for  a  few  thousands  who  prosper  in  material  things 
unduly.  That  sort  of  thing  has  gotten  to  be  very  fully 
established  as  a  recognized  fact  —  so  completely  that  every- 
body on  both  sides  of  this  question  would  have  to  acknowl- 
edge it  to  be  true. 

Now  what  is  the  basis  of  this  situation  of  inequality? 
The  basis,  we  will  say,  for  the  sake  of  getting  nearer  to  our 
own  discussion,  is  selfishness;  and  now  let  us  clearly  see  a 
distinction  which  everybody  ought  to  learn  to  draw  in  this 
question.  Does  this  mean  a  personal  individual  selfishness? 
Does  it  mean  that  such  rich  men,  such  rich  women,  all 
rich  families,  are  selfish  and  are  hanging  on  to  whatever 
advantage  in  life  they  may  have  —  unwilling  to  part  with  it 


628  HENRY     BAIRD     FAVILL 

to  other  people?  Now,  you  know  perfectly  well  that  it  is 
not  so;  that  there  is  not  a  potentate  in  the  world,  of  great 
political  power,  or  great  money  power— the  Czar  of  Russia, 
Pierpont,  Morgan,  or  anybody  you  may  choose — who,  if 
he  could  settle  this  whole  question  by  divesting  himself  of 
ever\"thing  he  had,  would  hesitate  for  a  second  to  do  it. 
You  know  that  anybody  who  could  solve  this  problem  by 
his  personal  act  would  do  it  gladly.  So  it  is  not  right  to 
regard  this  thing  as  essentially  individual  selfishness.  On 
the  other  hand,  it  is  true,  I  think,  that  when  individuals 
group  themselves  upon  one  side  or  another  of  these  ques- 
tions, and  get  into  larger  and  larger  groups,  up  to  the  point 
where  we  have  great  classes  —  as  between  the  masses  of 
people  and  the  people  who  have  great  financiali  nterests  — 
they  do  tend  to  get  together  into  aggregations  or  classes, 
and  at  that  point  there  is  not  the  slightest  question  that  we 
do  find  the  most  alarming  class  selfishness.  It  is  out  of 
this  situation  that  have  grown  our  great  governmental, 
political,  and  economic  conditions,  which  amount  to  such 
terrible  bondage  in  many  ways,  so  that  at  this  point  nobody 
quite  sees  the  way  out.  Nevertheless,  I  think  there  is 
undoubtedly  a  way  out,  and  the  question  is  how  to  get  into 
operation  the  forces  which  are  going  to  gradually  evolve  the 
way  out  of  it.  And  so  we  come  to  this  great  progressive 
movement  —  which  is  not  only  in  the  United  States,  but  in 
England,  Germany,  and  every  civilized  country  —  a  move- 
ment civilized  and  advanced.  It  is  true  that  there  is  a 
great  party  in  the  world  which  is  moving  toward  the  aboli- 
tion of  special  privilege  and  toward  the  creation  of  greater 
equality,  without  exactly  knowing  what  it  means  by  greater 
equality.  If  some  party  of  progressives  could  at  this 
moment  wipe  out  all  distinctions  and  start  anew,  that  would 
not  answer  the  question  because  of  the  great  time  necessary 
to  change  certain  tendencies  in  human  nature.  The  same 
situation  would  again  come  about,  that  is,  if  the  whole  thing 
went  on  from  a  perfectly  new  start  under  the  old  human 


MISCELLANEOUS  629 

impulses.  vSo  nobody  quite  sees  the  way  out.  Neverthe- 
less, it  is  pretty  clear  that  the  awakening  of  a  class  con- 
sciousness which  shall  offset  class  selfishness  is  not  only  the 
most  immediate  step  to  take,  but  probably  the  most  neces- 
sary step.  It  is  even  more  clear  that  we  have  got  to  get 
into  mass  movements,  into  a  corrective  forward  movement, 
before  these  things  can  be  very  much  straightened  out. 

Well,  even  so,  I  maintain  that  that  is  not  going  to  stop 
it,  and  it  is  all  upon  that  point  that  these  great  political 
parties  split.  Do  you  suppose  there  is  any  question  of  the 
great  conservative  party,  so-called,  being  just  as  honest, 
just  as  earnest,  just  as  much  lovers  of  humanity  as  the 
Progressives?  We  all  know  as  we  stop  to  look  at  these 
things,  at  our  neighbors  and  our  friends,  we  know  that 
people  on  one  side  of  that  contest  are  just  as  good  and 
honest  and  earnest  as  on  the  other.  There  is  no  doubt 
that  there  is  a  political  prejudice  to  a  certain  extent  back 
of  it.  I  say  that  to  you  because  it  is  desirable  to  get  the 
illusions  out  of  our  minds  on  this  question  of  a  political  split 
and  division. 

But  suppose  we  reach  a  class  consciousness  and  project 
a  great  progressive  movement  in  the  world  looking  toward 
betterment  of  things.  Is  it  going  to  finally  and  fundamen- 
tally solve  the  difficulties?  It  is  going  to  help.  We  are 
going  to  establish  standards  which  we  shall  not  change; 
one  thing  is  going  to  be  established  as  right,  and  another 
thing  is  going  to  be  established  as  wrong,  and  we  are  never 
going  back  from  that.     All  these  things  look  toward  progress. 

Yet,  all  these  are  man-made  standards,  and  have  no  deep 
and  fundamental  relation  to  the  evolution  of  human  affairs. 
After  the  class  consciousness  has  been  established,  after  the 
progressive  movement  has  gone  abroad  among  the  people 
and  they  are  moving  unanimously  towards  something  better, 
we  come  back  to  the  question,  is  that  enough?  Is  it  enough 
that  the  mass  of  people  shall  have  moved  toward  a  pretty 
good  thing  ?     Manifestly  that  is  not  going  to  solve  the  whole 


630  HENRY      BAIRD     FAVILL 

diflficulty,  by  any  means.  It  is  onl}^  the  first  step  in  the 
process.  The  question  then  arrises,  which  should  have 
come  first,  if  great  pohtical  parties  cannot  reach  the  solution 
by  giving  up  their  special  privilege  and  helping  the  mass  of 
people  along,  why,  what  is  there  that  can  attain  the  result? 

Let  me  call  your  attention  to  the  fact  that  all  masses  of 
people  are  made  up  of  individuals,  and  in  the  last  analysis 
the  quality  of  things  in  any  given  civilization  is  related,  not 
to  the  mass,  average  quality,  but  to  the  individual;  and  it 
brings  us  right  down  to  the  question  of  individual  standards, 
individual  measure,  individual  quality,  on  this  very  basis  of 
selfishness  and  unselfishness. 

I  think  I  should  have  great  difficulty  if  I  undertook  to 
define  to  you  what  is  selfishness  and  what  is  unselfishness. 

What  is  selfishness?  Let  us  think  about  it  for  a  minute. 
Going  on  blindly,  seeking  our  own,  doing  the  best  for  our- 
selves, ignoring  everybody  else,  perhaps  would  be  regarded 
as  selfishness.  Deliberately  seeking  to  do  the  best  for 
others,  always  ignoring  ourselves,  would  be  unselfishness. 
So,  it  is  only  for  practical  purposes  that  we  have  got  to  con- 
sider selfishness  and  unselfishness  as  being  opposites,  which 
is  not  strictly  true.  But  to-day  we  will  talk  as  though  that 
were  so. 

We  find  many  people  defending  themselves  in  conduct 
that  we  charge  them  with  pursuing  upon  the  basis  of  selfish- 
ness—  we  find  them  defending  themselves  upon  the  basis  of 
fundamental  unselfishness.  They  say,  "It  is  best  that  we 
do  so-and-so ;  it  accrues  to  our  advantage,  but  on  the  whole 
it  is  for  the  good  of  all."  That  may  be  true,  or  it  may  not. 
The  burden  of  proof  is  heavy  on  the  individual. 

When  we  come  to  unselfishness,  we  also  find  it  very  hard 
to  be  certain.  We  do  a  given  thing,  we  make  a  given  effort 
to  do  something  for  somebody  else.  Stop  and  think  of  all 
the  ramifications  of  that !  Does  it  come  back  to  ourselves, 
to  our  advantage  or  not  ?  In  a  large  proportion  of  cases  our 
unselfish  act  comes  back  to  our  advantage,  and  really  takes 


M  I  S  C  IC  I.  L  A  N  I<:  ()  IJ  S  631 

the  unselfishness  out,  because  self-interest  is  really  more 
promoted  by  an  apparently  unselfish  act  than  we  would  be 
willing  to  admit.  How  are  we  going  to  adjust  our  minds 
to  that  situation?  How  are  we  going  to  find  out  what  is 
the  really  unselfish  act  and  what  is  not,  considering  the 
complex  relationship  that  we  occupy  to  others  and  consid- 
ering that  everything  that  we  do  reacts  upon  ourselves,  so 
that  the  thing  in  the  unselfish  act  may  be  the  most  advan- 
tageous thing?  It  is  a  very  difficult  question,  and  it  is  a 
question  that  I  present  to  you  merely  to  think  about.  It 
is  a  question  that  comes  back  to  everyone  of  us  to  settle 
for  ourselves.  I  hope  that  these  things  will  become  more 
automatic  with  us  so  that  we  will  not  have  to  stop  and  con- 
sider; I  hope  we  may  come  to  the  time  when  we  may  follow 
our  instinct  without  asking  questions.  Nevertheless,  it  is 
well  for  us  to  ask  ourselves  what  our  motives  are  —  what  our 
real  attitude  is  on  this  question  of  selfishness  and  unselfish- 
ness. It  will  not  do  to  simply  find  that  we  are  giving  of  our- 
selves lavishly;  it  will  not  do  to  consider  that  we  are  giving 
of  our  material  resources.  That  does  not  prove  anything. 
Suppose  I  have  something  on  my  mind  that  I  want  to  do. 
I  want  to  do  it  terribly.  I  want  to  give  a  large  sum  of 
money  —  I  want  to  do  it.  Why?  It  is  quite  conceivable 
that  I  want  to  do  it  to  satisfy  something  inside  me  —  for 
personal  gratification.  Unless  it  comes  to  the  point  where 
we  do  not  care  for  our  own  gratification  and  are  not  willing 
to  consider  any  of  the  effects  upon  ourselves,  we  really  are 
not  deserving  of  the  quality  which  we  are  trying  to  describe 
in  this  discussion  of  unselfishness.  And  so,  when  you 
come  to  analyze  almost  any  of  your  acts,  almost  any  of  the 
things  that  you  do  in  life,  you  will  find  them  very  complex, 
and  you  can  not  be  sure,  without  stopping  to  think  about  it, 
whether  this  thing  3^ou  want  to  do  for  somebody  else  is 
selfish  or  unselfish.  But  there  must  be  a  dividing  line  in 
there  somewhere ;  a  dividing  line  must  be  the  essence  of  this 
situation. 


632  HENRY     BAIRD     FA  V  ILL 

Let  us  come  to  the  simplest  problem.  Supposing  that 
Robinson  Crusoe  is  before  us,  so  that  we  have  to  consider 
his  case.  He  is  alone.  The  presumption  is  that  he  will  do 
the  best  thing  for  himself.  If  there  is  any  food  here,  he  will 
eat  it;  if  there  is  any  raiment,  he  will  use  it;  if  there  is  any 
other  actual  advantage,  he  will  take  it.  No  one  will  question 
his  right  to  anything  for  his  advantage  under  the  circum- 
stances. Suddenly  there  comes  into  the  situation  another 
individual.  The  same  food  is  here,  the  same  raiment,  the 
same  advantage  or  disadvantage.  Do  the  same  principles 
of  ethics  apply  to  him  now  as  applied  to  him  before  the 
second  individual  came?  If  he  is  an  animal,  yes.  If  he  is 
a  savage,  yes.  If  he  is  in  any  of  the  classes  of  people  that 
have  not  come  under  our  rules  of  ethical  development,  yes. 
But  this  is  not  true  under  our  ethical  conception.  The  fact 
is,  the  minute  another  individual  came  into  that  situation, 
it  changed.  If  there  is  only  a  limited  amount  of  food,  and 
of  raiment,  by  right  they  belong  equally  to  the  second. 
Why  is  there  this  ethical  distinction  which  comes  along  the 
minute  one  man's  circle  begins  to  impinge  upon  another 
man's  circle?  I  can  not  answer  that,  except  that  one  knows 
inside  of  himself  that,  in  that  simple  situation,  unless  you 
are  going  to  open  the  question  of  strength,  the  rights  of  the 
second  are  equal  to  those  of  the  first.  So,  you  will  see  that 
the  question  of  what  Robinson  Crusoe  had  to  do  about  it 
was  very  largely  a  question  of  his  frame  of  mind.  In  other 
words,  the  question  of  selfishness  was  a  question  of  his  atti- 
tude, and  the  question  of  unselfishness  was  a  question  of  his 
attitude. 

This  is  the  word  that  I  want  to  say  to  you  in  conclusion 
—  that  it  is  not  at  all  primarily  a  matter  of  what  you  do; 
it  is  not  primarily  a  matter  of  what  you  say ;  it  is  primarily 
a  matter  of  your  attitude  of  mind  toward  yDur  neighbor. 
If  your  attitude  of  mind  toward  your  neighbor  is  such  that 
you  are  willing  that  your  neighbor  should  have,  without  any 
question,  everything  that  belongs  to  him  from  every  point 


MISCELLAN  KOUS  O33 

of  view,  the  foundations  of  unselfishness  exist  in  you.  If  you 
are  not  willing  that  your  neighbor  should  have  everything 
that  belongs  to  him,  the  foundations  of  selfishness  are  in  you. 

But  it  brings  us  at  once  to  a  very  practical  question  that 
we  have  to  meet  every  day --How  am  I  going  to  tell  what 
belongs  to  my  neighbor  in  the  ordinary  relations  of  life? 
Here  in  the  school,  with  my  classmates,  running  along  as  we 
do,  side  by  side,  getting  this  and  that  from  our  education, 
how  am  I  going  to  know  what  belongs  to  my  neighbor  and 
what  does  not  belong  to  my  neighbor?  Right  there  is  the 
difficult  question.  If  you  undertake  to  sit  down  and  decide 
for  yourself  what  your  neighbor  has  a  right  to  from  you, 
you  will  be  full  of  difficulties,  and  you  are  quite  likely  to  sit 
there  deciding  until  the  time  to  do  anything  about  it  has 
gone  by.  It  is  an  attitude  of  mind,  and  for  practical  pur- 
poses and  under  the  development  of  present  day  methods 
of  thought,  we  have  got  to  make  a  wide  margin  in  favor  of 
our  neighbor.  You  cannot  draw  a  dividing  line  and  say, 
' '  On  this  side  are  my  rights,  and  on  that  side  are  my  neigh- 
bor's rights."  We  have  got  to  state,  "Only  these  are  my 
rights;  all  the  rest  of  them  are  my  neighbor's." 

This  is  the  only  real  solution.  Of  course  the  result  is  — 
assuming  that  our  neighbor  takes  the  same  position  —  that 
encroachment  can  never  occur.  The  only  legitimate  place 
where  you  can  stand,  yourself,  in  undertaking  to  deal  with 
this  question  of  selfishness,  is  on  this  platform  — "I  have  a 
right  to  my  life,  and  all  the  rest  is  my  neighbor's  if  he  needs 
it."  That  is  an  attitude  that  seems  extreme.  It  sounds 
as  if  one  were  trying  to  make  of  himself  a  groveling  worm. 
It  is  nothing  of  the  sort.  The  essential  of  the  situation  is 
faith;  faith  in  yourself,  faith  in  your  neighbor,  faith  in 
humanity.  And  the  essential  of  that  is  faith  in  civilization, 
in  goodness,  in  the  stability  of  things.  There  is  nothing  so 
desirable  to  cultivate  as  a  trust  in  every  kind  of  life  rela- 
tionship. Actually,  this  is  not  a  difficult  question.  Prac- 
tically, action  alwa^'s  brings  its  legitimate  reaction,  and  as 


634  HENRY     BAIRD     FAVILL 

a  matter  of  fact,  when  you  have  gotten  to  the  point  where 
you  can  say  without  reservation,  "I  do  not  want  anything 
of  my  neighbor's;  I  want  my  neighbor  to  have  everything 
that  belongs  to  him,"  the  tables  are  suddenly  turned  and  it 
is  difficult  to  stop  things  from  crowding  in  upon  you. 

This  whole  question  of  unselfishness  does  not  need  to  be 
complicated,  difficult  —  the  deciding  between  one  course  of 
action  or  another.  The  only  thing  that  you  have  got  to 
decide  really  is:  —  "How  down  inside  of  myself  do  I  feel 
toward  others?"  And,  if  down  inside  of  yourself  you  can 
feel  toward  others  in  keeping  with  this  proposition,  the 
details  will  take  care  of  themselves.  You  will  then  have  no 
question  to  decide. 


MISCELLANEOUS  635 


Delivered,  vSixth  Annual    Dinner  of  llic  ITnrveslcr  f^Inb,  Chicago, 

Feljruary  3,   191 6. 
Printed,  Harvcskr   World,  M.-m  h,    1916. 

HAVE   AN    OUTSIDE   INTEREST 

I  DO  not  feel  an  entire  stranger  in  this  organization  — 
although  it  is  the  first  time  I  have  had  the  privilege 
of  appearing  before  you  —  as  I  have  some  relation  to 
the  Company  in  an  advisory  medical  capacity.  My  knowl- 
edge of  this  organization,  acquired  in  various  ways,  has 
convinced  me  that  from  the  standpoint  of  medical  service, 
from  the  standpoint  of  solicitude  for  the  genuine  welfare  of 
the  personnel  of  its  organization,  this  Company  is  unique. 
I  know  whereof  I  speak,  not  only  as  to  this  Company,  but 
as  to  others. 

The  questions  that  I  want  to  bring  to  you  to-night  are 
serious  ones,  not  relating  to  the  Company's  internal  affairs, 
but  relating  to  ourselves  —  to  you  and  me  alike,  as  we  stand 
in  the  community;  questions  that  come  to  us,  perhaps, 
more  seriously  this  year  than  in  any  year  of  our  lives,  or  of 
anybody's  life.  In  the  course  of  my  profession  I  have  often 
had  occasion  to  counsel  with  men  of  various  ages,  men 
along  in  years  but  not  old  so  far  as  the  conduct  of  their 
business  is  concerned.  They  have  asked  me  as  to  their 
physical  capacity  to  go  on  with  their  business,  and  the 
commonest  thing  is  to  have  a  man  say  to  me  under  those 
circumstances :  ' '  Doctor,  if  I  give  up  my  business  what  am 
I  going  to  do?  I  can't  get  along  without  my  business. 
I  can't  stand  it  to  be  out  of  business."  The  answer  would 
always  be,  if  the  circumstances  would  permit  it:  "Do  not 
give  up  3^our  business.  It  is  better,  even  in  a  measure,  to 
sacrifice  yourself,  than  to  give  it  up." 

But  w^hy  should  such  circimistances  exist?*  With  men 
along  in  years,  not  onh^  captains  of  industry',  but  those  in 
the  rank  and  file  of  life,  men  in  every  walk  and  vocation, 


636  HENRY     BAIRD     FAVILL 

men  in  every  position  of  headship  or  employment  in  a 
business  —  with  such  men  why  should  the  question  arise: 
"What  am  I  going  to  do  when  I  am  not  forced  by  daily 
requirement  to  go  on  in  a  strenuous  way  with  my  business? " 
In  an  economic  sense,  it  should  be  open  to  every  man,  at  a 
certain  point  in  his  life,  to  determine  whether  to  continue 
his  business  or  not.  As  a  matter  of  fact,  however,  their 
particular  circumstances  prevent  some  men  from  having 
that  choice.  The  simple  question  underneath  the  dilemxma 
in  which  men  are  placed  in  facing  such  an  inquiry  is  this: 
What  other  resources  have  they,  in  the  conduct  of  their 
life,  that  will  bring  them  any  considerable  degree  of  con- 
tentment or  happiness  ?  The  unfortunate  thing  in  all  walks 
of  life  is  that  men  under  those  circumstances  are  without 
resources,  they  are  without  any  habitual  training  of  thought 
or  experience  that  leads  them,  by  a  natural  process,  into 
any  outside  field  of  interest  which  will  employ  the  later 
years  of  their  lives,  and  so  save  them,  toward  the  end  of 
their  active  careers,  from  a  condition  of  comparative  use- 
lessness,  discontent,  and  almost  unhappiness. 

Do  not  think,  gentlemen,  that  I  am  overdrawing  this 
picture ;  I  am  really  stating  to  you  a  very  human  situation 
which,  naturally,  has  not  occurred  to  you  very  often.  Most 
of  you  are  young  men  —  in  the  full  prime  of  strength  and 
ambition  and  energy.  But  there  will  come  a  time  in  the 
lives  of  every  one  of  you  (and  it  is  not  such  a  very  far  cry 
from  thirty,  thirty-five,  forty,  on  to  fifty,  fifty-five,  and  six- 
ty) when  you  must  seriously  consider  what  you  are  to 
do  for  the  remainder  of  your  lives.  I  ask  you  now  to  con- 
sider, in  the  simple  terms  of  common  sense,  whether  you 
ought  to  go  to  the  end  of  your  tether — to  the  time  when 
you  are  no  longer  in  business  —  without  having  life  so  much 
within  your  grasp  that  you  can  step  from  one  sphere  of 
activities  to  another  without  feeling  that  you  are  taking 
that  step  almost  in  desperation.  Is  it  not  unwise  for  us 
to  live  the  earlier  part  of  our  lives,  during  the  formative 


M  I  SC  E  L  I>  A  N  lOO  U  S  637 

period,  in  such  a  way  that  our  latter  days  are  crystallized 
into  something  little  short  of  a  prison  house?  The  time 
to  answer  such  a  question  is  now  -  not  years  hence,  when 
it  is  forced  upon  us. 

In  my  judgment,  every  phase  of  your  present  activities, 
of  your  duties  to  the  Company,  will  be  enhanced  or  aug- 
mented by  a  judicious  intermixture  of  other  interests  than 
your  business.  In  youth  it  is  easy  to  find  pursuits  more  or 
less  light  and  pleasurable  in  character.  As  you  get  older 
things  begin  to  pall  upon  you.  It  will  not  be  as  clear  to 
you  what  the  next  decade  will  bring  forth  to  relieve  that 
monotony  of  life  that  business  makes,  and  free  you  from 
the  apprehension  that  comes  to  every  man,  concerning  what 
old  age  will  bring  to  him.  The  things  that  you  can  rely 
upon  to  meet  this  situation  in  youth  you  can  not  count 
upon  in  old  age.  Therefore  it  is  manifest  that  you  should 
now  take  thought  on  this  subject  at  every  point  of  your 
work,  and  thus  increase  your  value  to  the  Company  that 
employs  you.     I  say  this  after  much  reflection. 

What  do  I  mean  by  outside  interests?  Bear  in  mind 
.that  interests  are  born  of  familiarity  with  subjects,  that 
interests  are  the  outgrowth  of  intimate  knowledge  of  things. 
It  does  n't  make  so  much  difference  what  things.  Let  us 
take  our  popular  national  craze  of  baseball.  What  is  a 
baseball  ' '  fan  ? "  A  man  who  simply  goes  to  a  good  many 
baseball  games  and  enjoys  them  and  goes  away  and  forgets 
them?  Not  at  all.  It  is  the  man  that  knows  the  "dope." 
And  he  knows  it  through  and  through,  and  the  more  he 
knows  it  the  more  of  a  "fan"  he  is. 

So  it  is  with  every  phase  of  our  lives.  The  thing  which 
becomes  an  interest  to  us  is  the  thing  into  which  we  put 
our  intelligence.  The  fact  is,  gentlemen,  that  circumstances 
never  have  any  intrinsic,  pleasurable  quality  in  themselves. 
The  pleasure  of  life  and  the  pleasure  of  circumstances  is 
derived  from  what  we  put  into  them,  not  from  what  we  take 
out  of  them.     There  is  no  question  about  it.     So  I  am 


638  HENRY      BAIRD     FA  V  ILL 

urging  upon  you  as  a  general  proposition  to  have  interests, 
really  definite,  consistent  interests,  that  you  may  reason- 
ably and  honestly  call  intellectual  interests,  in  some  subject 
or  other  outside  your  business. 

The  other  day,  in  talking  with  a  friend  about  various 
public  activities  in  which  we  had  been  engaged  together,  he 
said,  with  some  feeling  of  discouragement:  "There  is  noth- 
ing difficult  about  this  matter  if  you  can  get  the  ear  of  honest 
men."  He  was  referring  to  municipal  affairs,  to  a  number 
of  situations  that  are  important.  To  that  I  would  like 
especially  to  call  your  attention. 

The  obligation  that  rests  upon  all  men  who  are  in  digni- 
fied employment,  men  of  respectable  connections,  of  ele- 
vated business  ethics,  is  to  take  part  in  their  community 
life.  Do  you  do  it?  Some  of  you,  I  know,  do  it  tremen- 
dously. Many  of  you  would  if  you  just  knew  how.  I 
venture  to  say,  however,  that  in  the  minds  of  this  splendid 
body  of  men  here  to-night  there  is  not  the  conviction  regard- 
ing this  ethical  relation  to  community  affairs  that  there 
should  be.  Think  that  over.  Let  me  say  with  all  the  em- 
phasis I  can  that  every  unit  of  good  that  you  can  confer 
on  the  community  by  participating  in  its  affairs  will  be  re- 
turned to  you  in  personal  reward  tenfold  through  the  inter- 
est that  will  come  to  you  from  an  intelligent  understanding 
of  the  needs  of  your  community. 

We  live  in  a  wonderful  country,  under  a  wonderful 
government,  complex,  ramified,  intangible,  and  rather  loose- 
ly knit.  None  of  us  knows  definitely  much  about  affairs 
outside  his  business  —  particularly  the  social  and  political 
affairs  around  him.  In  the  light  of  the  turmoil  which  now 
exists  in  the  world;  with  the  internal  trepidation  every  one 
of  us  feels  as  to  what  is  coming  next;  with  the  serious 
thought  that  a  large  percentage  of  the  men  here  to-night 
may  never  meet  again  if  things  should  go  from  bad  to  worse 
during  the  next  two  or  three  years  —  with  this  in  mind  I 
ask  you,  gentlemen,  to  earnestly  answer  to  yourselves  the 


M  I  S  C:  K  L  L  A  N  K  O  U  S  639 

question:  "What  arc  you  doing  toward  the  stabilizing  of 
your  government  —  not  your  National  government  only  but 
your  State  and  Municipal  government?"  Your  answer  may 
be:  "What  can  1  do?  What  influence  have  I  in  municipal 
affairs?"  Let  me  assure  you  that  the  one  force  which  is  of 
the  greatest  consequence  in  the  United  States,  the  one  force 
that  can  be  mobilized  to  great  advantage,  is  public  opinion, 
is  independent  thought,  is  an  intelligent  understanding  of 
the  issues,  be  they  national  or  municipal.  Therefore,  in 
the  name  of  all  the  organizations  that  are  reaching  out  for 
an  honest  public  opinion,  I  urge  you  to  realize  that  every- 
one who  interests  himself  intelligently  about  his  municipal 
affairs,  thereby  determining  what  his  ballot  shall  be,  is 
rendering  yeoman  service  on  behalf  of  his  country. 

Bear  in  mind,  gentlemen,  that  there  are  a  thousand  ways 
in  which  you  can  bring  yourselves  into  this  relationship. 
There  are  the  ways  of  philanthropy,  the  ways  of  civics,  the 
ways  of  politics,  the  ways  of  all  kinds  of  activities.  It  is 
not  the  specific  group  that  you  join;  the  point  is  to  join 
some  group  which  has  for  its  purpose  an  intelligent  under- 
standing of  the  problems  before  ,us  as  a  people  and  a  deter- 
mination to  do  its  best,  whatever  it  may  be,  toward  the 
solution  of  those  problems.  Never  in  the  history  of  this 
country  has  it  been  so  imperative  that  every  honest,  able- 
bodied,  red-blooded,  clear-thinking  man  should  have  his 
mind  set  on  what  is  the  right  thing  for  him,  for  his  com- 
munity and  his  country  to  do.  This  matter  does  not 
necessarily  turn  upon  your  expression  of  opinion.  It  turns 
finally  upon  the  clarity  of  your  thought.  You  can't  have 
a  clear  thought  without  an  outstretching  into  the  matter 
that  will  give  you  a  certain  kind  of  exact  knowledge.  You 
can't  have  an  exact  knowledge  unless  you  study  —  unless 
you  think.  You  can  not  very  w^ell  study  this  subject  unless 
somewhere  or  other  you  get  into  such  a  group  as  I  have 
mentioned. 

I  began  by  speaking  about  your  individual  happiness 


640  HENRY     BAIRDFAVILL 

because  I  know  that  anything  you  can  do  along  this  Hne 
will  redound  to  3^our  individual  happiness;  but  aside  from 
that,  and  beyond  it,  I  say  to  each  one  here  to-night,  with 
all  the  earnestness  that  I  can  bring  to  bear,  and  quietly 
and  seriously:  Your  country  needs  you,  needs  you  more 
than  it  ever  needed  you  in  its  history. 


Thou  art  not  alone,  and  thou  doest  not  belong,  to  thyself. 
Thou  art  one  of  My  voices,  thou  art  one  of  My  arms. 
Speak  and  strike  for  Me.  But  if  the  arm  be  broken,  or  the 
voice  he  weary,  then  still  I  hold  My  g^round:  I  fight  with 
other  voices,  other  arms  than  thine.  Though  thou  art  con- 
quered, yet  art  thou  of  the  army  which  is  never  vanquished. 
Reiiiriiiher  thai  a)id  thou  wilt  fight  even  unto  Death. 

RoMAiNK   Roi.i.AND,   "  J^an  Cliristophp,"  Part  IX. 


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